Proliferative verrucous leukoplakia: A case report with emphasis on diagnosis and treatment

Abstract

Bhagyalaxmi Hongal, Priya Shirish Joshi, Appasaheb Sanadi

Proliferative verrucous leukoplakia (PVL) is characterized by development of multiple keratotic plaques with roughened surface projections. Since its introduction in 1985 by Hansen et al., PVL of the oral mucosa still remains an enigma and is difficult to define as a sub-entity of leukoplakia. Although the lesion typically begins as simple, flat hyperkeratosis indistinguishable from ordinary leukoplakic lesion, PVL exhibits persistent growth and eventually becomes exophytic and verrucous in nature. As the lesion progresses, they may go through a stage indistinguishable from verrucous carcinoma but may later develop dysplastic changes or transform into full-fledged squamous cell carcinoma usually within 8 years of initial PVL diagnosis. PVL is unusual among the leukoplakia variants in having a strong female predilection and minimal association with tobacco usage. Presenting here, a case of PVL transforming into verrucous carcinoma with areas of suspected malignancy in a 53-year-old male with habit of chewing tobacco quid and beedi smoking 4-6 times a day since 20 years, with a chief complaint of pain and burning sensation of the oral cavity and multiple oral lesions for 1 month. This paper will elaborate typical behavior pattern of the lesion and will discuss this rare entity in light of current information.