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Jason S. Isenberg '08

An Institutional and Comprehensive Review of Laryngeal Leukoplakia.

The progression and timing of dysplastic and malignant changes of vocal fold leukoplakia is unclear and poorly understood. The present study reviewed the published literature and institutional data to understand the biologic behavior of this lesion. 74 patients (103 biopsies) with laryngeal leukoplakia confined to the true vocal folds were reviewed from 1990-2005. 47/103 (46%) were non-dysplastic. Of the dysplastic lesions, mild, moderate, severe/squamous cell carcinoma (SCCa) in situ and SCCa was seen in 9/103 (9%), 6/103 (6%), 18/103 (17%) and 23/103 (22%), respectively. The average follow-up period was 26.4 months (1-134 months). Seven patients underwent malignant change on serial biopsies. Non-dysplastic patients were 53.4, while those with invasive carcinoma were 67.9 years old. Additionally, a Medline literature search from 1965-2005 for the following MESH subjects "pre-malignant laryngeal lesions, laryngeal dysplasia, vocal cord dysplasia or hyperkeratosis of the larynx" was performed. Twelve manuscripts were included in the meta-analysis. 828/1927 (46%) revealed dysplasia. In follow-up, patients with initial biopsies demonstrating no dysplasia, mild/moderate dysplasia or severe dysplasia/SCCa in situ , SCCa developed in 29/999 (3%), 64/563 (11%) and 52/292 (18%) of these lesions.

Therefore, leukoplakia, absent dysplasia, is associated with an increased risk of developing SCCa and the risk of developing malignancy appears to correlate with the severity of dysplasia noted on initial biopsy. Additionally, advanced age at the time of initial biopsy is associated with an increased incidence of SCCa. Future studies, such as genomic evaluation of this lesion, are needed to further characterize their biologic behavior.

 


 

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Otolaryngology Surgery University of Wisconsin Department of Surgery
First published: 07/15/02 Last updated: 11/24/09 webmaster@surgery.wisc.edu
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