Materiały źródłowe

• #1 Leukoplakia | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/leukoplakia

  Leukoplakia treatment is most successful when a patch is found and treated early, when it’s small. Regular checkups are important. So is checking your mouth regularly for changes to your cheeks, gums and tongue. […] For most people, getting rid of the source of irritation such as stopping tobacco or alcohol use clears the condition. […] When these lifestyle changes do not work or if the patch shows early signs of cancer, the treatment plan may include: […] A surgery to remove the leukoplakia patches. Patches may be removed using a small surgical knife. A laser, a tool that uses heat, or a tool that uses extreme cold also can remove the patch and destroy cancer cells. […] Follow-up visits to check the area. Once you’ve had leukoplakia, it’s common for it to come back. […] If your doctor or other healthcare professional recommends treatment, it may include:

• #2 Leukoplakia Patches: Causes, Symptoms, and Treatments

  https://www.webmd.com/oral-health/dental-health-leukoplakia

  Removing the source of irritation that’s causing leukoplakia is often enough to make it go away. For example, if a rough tooth or an irregular surface on a denture or a filling is rubbing the inside of your mouth, the tooth will be smoothed and dental appliances repaired. If leukoplakia is caused by smoking, cutting back or stopping smoking or using other tobacco products can help. […] Leukoplakia is usually harmless, and patches often clear in a few weeks or months after the source of irritation is removed. If that doesn’t work, the lesion may need to be removed with a scalpel, laser, or by freezing. Hairy leukoplakia usually doesn’t need any special treatment. But since it’s a sign that your immune system may not be working well, your doctor may look for ways to boost your immune system. Sometimes, they might give you an antiviral drug.

• #3 Leukoplakia as an oral cancer symptom: 7 things to know | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/what-is-leukoplakia-symptoms–risk-factors-and-treatment.h00-159700701.html

  Leukoplakia can be treated with surgery or lasers. […] Leukoplakia may go away on its own. If you remove the source of irritation, the affected tissue can sometimes heal. But see a doctor or dentist if it doesn’t go away or at least get better within two weeks. […] Leukoplakia doesn’t usually turn into cancer. But it can be a pre-cancerous condition, so it’s important to get checked it out.

• #4 Leukoplakia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17655-leukoplakia

  Healthcare providers treat leukoplakia by removing the patches in your mouth. They may remove the patches with a scalpel. Other potential procedures include: […] Using a laser to remove the patches. […] Using light-activated cancer drugs (photodynamic therapy). […] Using cryotherapy, which is extreme cold that freezes and kills abnormal cells and removes the patches. […] Using an electrically heated needle or other instrument to remove the patches (electrocauterization). […] Surgery to remove leukoplakia is the only way to make it go away.

• #5 Specialized Leukoplakia Treatment | POM Dental Studio

  https://www.pomdental.com/leukoplakia-treatment/

  Leukoplakia Treatment: What is Leukoplakia and Why Vigilance is Important? […] If you believe you have Leukoplakia, then you are advised to call us at Peace of Mind Dental Studio and book an appointment so we can have a look at the problem before it escalates into a malignancy. […] Treatment of Leukoplakia […] There are multiple ways to treat leukoplakia. It is advised to go through them once so you can choose the treatment method that suits you best. […] Surgical Removal: The most common method to remove leukoplakia is surgical removal of patches with a scalpel. Anesthesia is administered, and the patches are removed one by one. […] Laser Therapy: A low-powered laser beam is used to destroy the tissue which causes leukoplakia. […] Cryotherapy: In cryotherapy, the tissues are frozen to a temperature where the cells become dormant and die, and the patches are removed.

• #6 Application of 5-aminolevulinic acid-mediated Waterlase-assisted photodynamic therapy in the treatment of oral leukoplakia | Scientific Reports

  https://www.nature.com/articles/s41598-022-13497-3

  Photodynamic therapy (PDT) is an alternative microinvasive approach with satisfying results in the treatment of oral leukoplakia (OL). PDT combined with laser irradiation shows promise, safety and efficacy in treating OL. ALA-mediated PDT combined with YSGG is effective in treating OL, particularly that with mild to moderate dysplasia. However, severe dysplasia may present undesirable effects, and the mechanism remains to be further investigated. The main goal of the treatment of OL is to prevent malignant transformation and even reduce or eliminate lesions. Medical interventions, such as vitamin A, retinoids, beta-carotene or bleomycin cannot reduce the possibility of oral cancer development and have low efficiency with a long treatment time. Therefore, surgical methods, including conventional excision, cryosurgery therapy, electrocauterization and various forms of laser ablation, are the preferred choice in OL management for many clinicians. Photodynamic therapy (PDT) is a less invasive method that can successfully be applied in the treatment of premalignant and malignant disorders of the skin, digestive tract, lungs, and genitourinary mucosa with vastly reduced morbidity and disfigurement. ALA-PDT is currently a notable treatment selection for oral premalignant lesions because it results in good functional and cosmetic outcomes with the lowest scarring, slight postoperative pain and mild edema. In summary, our study shows that combining PDT with YSGG is effective in the treatment of OL, which is a promising treatment method for achieving excellent outcomes for patients.

• #7 Treating Oral Leukoplakia with a 532-nm Pulsed Diode Laser

  https://www.jkslms.or.kr/journal/view.html?doi=10.25289/ML.2019.8.1.39

  A 50-year-old Korean female with oral erythro-leukoplakia was treated using a 532-nm Diode laser at 6 Watts with a pulsed width of 25 milli-seconds. After two months following the laser treatment, the resected region was well-healed without any significant scar contracture. We suggest that the use of the 532-nm Diode laser can be a safe and effective treatment modality for patients suffering from oral leukoplakia. […] Various nonsurgical treatment modalities for oral leukoplakia have been reported, but they have shown a disadvantage of high relapse after treatment-discontinuing. […] The advantages of the laser such as hemostatic effect, precise resection, and minimal collateral damage have rendered the laser to be applied in the surgical resection of oral leukoplakia. […] The 532-nm Diode laser excision may be a useful technique to remove oral leukoplakia with minimal collateral tissue damage through the photocoagulation of microvascular structure around basement membrane.

• #8 Specialized Leukoplakia Treatment | POM Dental Studio

  https://www.pomdental.com/leukoplakia-treatment/

  Photodynamic Therapy: Photodynamic therapy includes using light-activated cancer drugs to prevent such patches from forming. […] Is leukoplakia cancerous? […] It is not cancerous in all cases, but certain types can be malignant if not addressed in time. Consult Peace of Mind Dental Studio today and let our experts diagnose the problem before it escalates.

• #9 Laser therapy decreases oral leukoplakia recurrence and boosts patient comfort: a network meta-analysis and systematic review | BMC Oral Health | Full Text

  https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-024-04179-9

  The results revealed that Er,Cr:YSGG laser, CO2 laser combined with PDT, and Er:YAG laser demonstrated superior efficacy compared to surgical excision in preventing OLK recurrence. Additionally, all the laser-based treatments outperformed surgical excision in minimizing intraoperative hemorrhage and postoperative pain scores on the first postoperative day, with Er,Cr:YSGG and Er:YAG lasers demonstrating the highest rankings in these respective categories. […] The present systematic review and network meta-analysis suggests that for patients with homogeneous OLK, Er,Cr:YSGG, Er:YAG, and CO2 lasers combined with PDT show promise in reducing post-treatment recurrence and improving patient comfort compared to surgical excision and other laser types.

• #10 Treatment Of Oral Leukoplakia By Er:YAG Laser: Current Relevance To Dental Practice

  https://www.scitechnol.com/peer-review/treatment-of-oral-leukoplakia-by-eryag-laser-current-relevance-to-dental-practice-uRnI.php?article_id=16900

  Laser ablation/vaporization is considered to be a safe and effective alternative technique for treating oral leukoplakia (OL) lesions. […] The literature demonstrated that Er:YAG laser could be considered an efficient and reliable method for treating OL. […] Uncomplicated healing was observed, moreover, favourable healing with lower or no recurrence rate or malignant transformation was observed. […] The rationale of surgical treatment is that it is indicated when the removal of OL altered tissue can prevent transformation of OL to oral cancer. […] Surgical treatments include excision by conventional surgery (scalpel, electrocoagulation and cryosurgery) and the use of lasers. […] Recently, different laser wavelengths have been recognised as an alternative advanced treatment modality in modern dentistry, namely due to the various intra- and postoperative benefits, such as extremely precise ablation and vaporisation, haemostasis (clearly visible working field), disinfection, decontamination, no need for sutures, minimal pain and swelling after surgery and, consequently, faster wound healing.

• #11 Treatment Of Oral Leukoplakia By Er:YAG Laser: Current Relevance To Dental Practice

  https://www.scitechnol.com/peer-review/treatment-of-oral-leukoplakia-by-eryag-laser-current-relevance-to-dental-practice-uRnI.php?article_id=16900

  The use of Er:YAG lasers for OL removal has gained increasing importance in recent years, either for superficial ablation/vaporisation in cases of hyperkeratotic lesions, or complete ablation of the epithelium and adjacent tissues in dysplastic lesions. […] Er:YAG lasers possess high absorption by water, minimising the thermal damage of the ablated tissue. […] Recently, some studies reported a lower recurrence rate and malignant transformation of OL lesions using different laser wavelengths. […] The present review has showed that Er:YAG laser can be reliable and effective in treating OL lesions. Its application resulted in a more favourable wound healing without thermal side effects and/ or complications and, more importantly with lower recurrence rates and malignant transformation of OL.

• #12 Interventions for treating oral leukoplakia to prevent oral cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6457856/

  None of the studies provided evidence that active treatment reduced the risk of oral cancer more than placebo: systemic vitamin A (RR 0.11, 95% CI 0.01 to 2.05; 85 participants, one study); systemic beta carotene (RR 0.71, 95% CI 0.24 to 2.09; 132 participants, two studies); and topical bleomycin (RR 3.00, 95% CI 0.32 to 27.83; 20 participants, one study). […] Some individual studies suggested effectiveness of some proposed treatments, namely, systemic vitamin A, beta carotene and lycopene, for achieving clinical resolution of lesions more often than placebo. […] The available evidence on medical and complementary interventions for treating people with leukoplakia is very limited. We do not currently have evidence of a treatment that is effective for preventing the development of oral cancer.

• #13 Vocal Folds Leukoplakia: The Efficacy of Vitamin A in the Initial Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9879634/

  Leukoplakia corresponds to a white lesion in the mucosa developed by the deposit of keratin in the epithelium, potentiated by chronic smoking. It is considered a preneoplastic lesion. Surgery is the most adopted treatment; however, non-surgical treatment is advocated by some authors. […] To evaluate the effectiveness of vitamin A in the management of vocal fold leukoplakia. […] In this study, the treatment with vitamin A at a dose of 100,000IU daily for 2 months was effective in reducing the laryngeal leukoplakia size in 62% of cases. […] Therefore, it is observed that the studies are scarce and present contradictory results. So, the objective of the present study was to evaluate the effectiveness of the initial clinical treatment with vitamin A on leukoplakia lesions of the vocal folds with a dosage of 100,000 units/day for 2 months.

• #14 Leukoplakia (Holistic) – Health Information Library | PeaceHealth

  https://www.peacehealth.org/medical-topics/id/hn-1230003

  Beta-carotene is the most widely used supplement in the treatment of leukoplakia, has been shown in studies to increase remission rate. […] Drug therapy with a synthetic, prescription form of vitamin A (known as Accutane, isotretinoin, and 13-cis retinoic acid) has been reported to be more effective than treatment with 50,000 IU per day of beta-carotene. […] Vitamin A has been shown to be effective against leukoplakia. […] A combination of whole green tea, green tea polyphenols, and green tea pigments painted on lesions may improve healing. […] According to a review of clinical trials, the combination of beta-carotene and vitamin E has led to complete or partial remissions in six of eight trials studying people with leukoplakia.

• #15 Natural treatments for leukoplakia | EBSCO Research Starters

  https://www.ebsco.com/research-starters/complementary-and-alternative-medicine/natural-treatments-leukoplakia

  Leukoplakia is a condition characterized by the appearance of white, grey, or red patches on the mucous membranes, particularly in the mouth and on the tongue, which can be sensitive to touch and certain foods. […] Natural treatment options have been explored, with lycopene, a carotenoid found in tomatoes and other fruits, showing promise as a potential remedy. Research suggests that lycopene may reduce symptoms of leukoplakia, with higher doses appearing more effective. […] Other substances such as vitamin E, beta-carotene, vitamin C, and curcumin have also been studied for their potential benefits in managing this condition. […] Overall, while natural treatments may offer some benefits, consultation with a healthcare professional is essential for personalized advice and management.

• #16 Natural treatments for leukoplakia | EBSCO Research Starters

  https://www.ebsco.com/research-starters/complementary-and-alternative-medicine/natural-treatments-leukoplakia

  Lycopene is a carotenoid, a close chemical cousin of vitamin A. […] One study suggests that lycopene also might be useful for treating leukoplakia. […] The results indicated that lycopene in either dose was more effective than placebo for reducing signs and symptoms of leukoplakia, and that eight mg daily was more effective than 4 mg. […] Other research indicates that vitamin E, Beta-carotene, and vitamin C may help put leukoplakia into remission, along with consumption of green tea. […] Curcumin, a derivative of tumeric, and curcumin-based therapy (nanocurcumin) has also been shown to reduce lesion size. […] It is also advised that patients avoid certain substances and behaviors, such as tobacco and smoking, respectively, as well as alcohol, as these substances can irritate leukoplakia and are also thought to be linked to the cause of leukoplakia.

• #17 Hairy Leukoplakia Treatment & Management: Medical Care, Consultations, Diet

  https://emedicine.medscape.com/article/279269-treatment

  As a benign lesion with low morbidity, oral hairy leukoplakia (OHL) does not require specific treatment in every case. Indications for treatment include symptoms attributable to the lesion, or a patient’s desire to eliminate the lesion for cosmetic reasons. The variable natural history of the lesion and its tendency toward spontaneous resolution should be considered in any management decision. Several treatment options are available. […] With highly active antiretroviral therapy (HAART) therapy, oral hairy leukoplakia usually decreases, but can return when HAART is decreased. Direct treatment of oral hairy leukoplakia with antivirals usually is not necessary. […] Systemic antiviral therapy usually achieves resolution of the lesion within 1-2 weeks of therapy. […] Oral therapy with acyclovir requires high doses (800 mg 5 times per day) to achieve therapeutic levels.

• #18 Hairy Leukoplakia Treatment & Management: Medical Care, Consultations, Diet

  https://emedicine.medscape.com/article/279269-treatment

  Valacyclovir (1000 mg 3 times a day) and famciclovir (500 mg 3 times a day) are newer antiviral drugs with higher oral bioavailability than acyclovir and can be dosed less often. Antiviral drugs inhibit productive Epstein-Barr virus (EBV) replication but do not eliminate the latent state of infection. Hairy leukoplakia often recurs several weeks after the cessation of antiviral therapy. […] Topical therapy with podophyllin resin 25% solution usually achieves resolution after 1-2 treatment applications. […] Podophyllin has cellular cytotoxic effects, but the mechanism of action in resolving hairy leukoplakia is not known. […] Again, hairy leukoplakia often recurs several weeks after successful podophyllin therapy. […] Topical therapy with retinoic acid (tretinoin) has been reported to resolve hairy leukoplakia.

• #19 Hairy Leukoplakia Treatment & Management: Medical Care, Consultations, Diet

  https://emedicine.medscape.com/article/279269-treatment

  Ablative therapy can also be considered for small hairy leukoplakia lesions. Cryotherapy has been reported as successful but is not widely used. […] Institution of HAART, considered to be the standard care in the United States, is useful in eliminating the lesions of oral hairy leukoplakia. […] Superinfection with Candida can be addressed with medical therapy.

• #20 Leukoplakia: Symptoms, Causes, Diagnosis, and Treatment

  https://www.verywellhealth.com/overview-of-leukoplakia-4586502

  Leukoplakia Treatment, therapy […] Usually, removing the source of the irritationsmoking, chewing tobacco, excessive alcohol use, or dental causesis enough to cure leuoplakia. […] If the leukoplakia is caused by a dental problem, a referral will be made to a dentist for correction of the ill-fitting dentures, jagged tooth, or other underlying cause. […] However, if there is a positive biopsy result, further treatment is necessary. Treatment of leukoplakia is most effective after early diagnosis. […] This may include: […] Immediate removal of all leukoplakia to stop the spread of the cancer: This may be done with a laser, scalpel, or a cold-freeze method with a probe (called a cryoprobe). […] Use of a prescription anti-viral medication if the diagnosis is hairy leukoplakia. […] Keep in mind that even after leukoplakia patches are removed, there is still an increased risk of oral cancer. […] In any case, you will need regular follow-up visits to check for recurring symptoms of leukoplakia (which are common). […] You will also need to learn to thoroughly and regularly perform self-inspections of the mouth.

• #21 Oral Leukoplakia for Otolaryngologists | AAO-HNS Bulletin

  https://bulletin.entnet.org/clinical-patient-care/article/22865154/oral-leukoplakia-for-otolaryngologists

  In 2020 an article from the University of Minnesota recommended biopsy initially for all white oral lesions concerning for oral leukoplakia. […] Furthermore, the authors described an active surveillance protocol based on histological grade and condition, with more frequent followups, and longer length of followup for more aggressive lesions. […] Rebiopsy is recommended on a semiregular basis for dysplastic lesions with higher grades. […] For example, for severe dysplasia, rebiopsy is recommended in three to nine months, while moderate dysplasia should be rebiopsied in 12-18 months. […] Despite the large volume of cases seen each year, the variable and unpredictable behavior of oral leukoplakia has made it difficult to establish guidelines for management. […] However, with recently suggested algorithms and survey responses, there is increasing interest to establish protocols and guidelines for management of oral leukoplakia in the future.

• #22 SciELO Brazil – Treatment of oral leukoplakia with CO₂ laser (10,600 nm): analysis of 37 cases Treatment of oral leukoplakia with CO₂ laser (10,600 nm): analysis of 37 cases

  https://www.scielo.br/j/bor/a/JQrqPWWWtmqQghVmjNssshB/

  In this study, the initial biopsy revealed epithelial dysplasia in 29 of 37 patients: 10 with mild dysplasia (27%), 8 with moderate dysplasia (21.6%), and 11 with severe dysplasia (29.7%). […] Despite the benefits of treating oral leukoplakia with a CO2 laser, many patients experience recurrences. […] In this study, recurrence outcomes were observed in 13 patients (35.1%). […] Lesion resolution occurred in 16 patients (43.2%) in this study, with a mean follow-up of 36.5 months. […] In the present study, malignant transformation occurred in eight patients (21.6%), with a mean of 50.6 months after CO2 laser treatment. […] The treatment of the lesions by CO2 laser was efficient in the removal of the lesions, and clinical resolution occurred in 16 patients (43.2%); however, it did not avoid clinical outcomes of recurrence in 13 patients (35.1%) or malignancy in 8 patients (21.6%).

• #23 Interventions for treating oral leukoplakia to prevent oral cancer | Cochrane

  https://www.cochrane.org/CD001829/ORAL_interventions-treating-oral-leukoplakia-prevent-oral-cancer

  The available evidence on medical and complementary interventions for treating people with leukoplakia is very limited. We do not currently have evidence of a treatment that is effective for preventing the development of oral cancer. Treatments such as vitamin A and beta carotene may be effective in healing oral lesions, but relapses and adverse effects are common. […] Larger trials of longer duration are required to properly evaluate the effects of leukoplakia treatments on the risk of developing oral cancer. High-quality research is particularly needed to assess surgical treatment and to assess the effects of risk factor cessation in people with leukoplakia.

• #24

  https://www.hsdm.harvard.edu/news/researchers-explore-immune-checkpoint-therapy-treat-aggressive-form-oral-cancer

  In one of the first clinical trials to explore treatment of an aggressive form of oral precancer with immune checkpoint therapy (ICT), researchers from the Harvard School of Dental Medicine (HSDM), Dana-Farber Cancer Institute, and other collaborators found promising results for treating a high-risk oral precancerous disease with ICT. […] Their study, Nivolumab for Patients With High-Risk Oral Leukoplakia published in JAMA Oncology, followed the treatment of 33 patients with high-risk oral proliferative verrucous leukoplakia (PVL), an uncommon but aggressive oral precancerous disease characterized by its tendency to progress to invasive oral squamous cell carcinoma in at least 60% of patients. […] This is the first study of its kind that treated this condition which is highly associated with cancer development, using systemic immunotherapy rather than surgery or laser, said Dr. Sook Bin Woo co-author of the article and associate professor of Oral Medicine, Infection, and Immunity at HSDM and program director of Oral and Maxillofacial Pathology based at Brigham and Womens Hospital.

• #25

  https://www.hsdm.harvard.edu/news/researchers-explore-immune-checkpoint-therapy-treat-aggressive-form-oral-cancer

  After treating leukoplakia lesions with Nivolumab, a targeted therapy drug that acts as an immune checkpoint inhibitor, findings showed a positive clinical response. […] Although few patients had complete lesion regression, this encouraging trial lays the groundwork for greater study by demonstrating potential clinical activity and acceptable safety with the use of ICT in a population with high-risk precancer. […] The data generated from this study regarding the mutations associated with PVL, as well as the types of immune cells within the lesion that affected treatment response, set the stage for further innovation regarding treatment of this and other precancerous lesions in the mouth, Woo said.

• #26 Leukoplakia: Symptoms, causes, and prevention

  https://www.medicalnewstoday.com/articles/317689

  Leukoplakia causes white patches or plaques to develop on the tongue and mucosa in the mouth. Doctors may prescribe medication to treat the condition. […] If the doctor suspects leukoplakia, they are likely to request a biopsy to rule out cancer. […] If cancer is not evident in the results, doctors typically recommend that a person stops using tobacco products. Doctors also advise good oral hygiene. […] If the patches do not clear up without treatment, a person may need an operation to remove leukoplakia. […] Doctors recommend frequent follow up appointments for on-going leukoplakia. If leukoplakia has resolved, a person may require yearly checkups. […] When the patches develop due to conditions such as HIV, a doctor might prescribe antiviral medications. […] If a doctor discovers precancerous or cancerous cells, they will carry out additional testing measures to determine the extent of the condition. Treatment will depend on which type of cells are present.

• #27 Leukoplakia: Symptoms, causes, and prevention

  https://www.medicalnewstoday.com/articles/317689

  Experts estimate that about 5% of oral leukoplakia may lead to oral cancer. […] Practicing good oral hygiene and stopping activities that damage or stress the mouth lining are the easiest ways to manage and prevent leukoplakia. […] Avoiding or quitting smoking and maintaining good oral hygiene are effective methods for reducing the risk of the condition.

• #28 Leukoplakia – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/leukoplakia/

  There are different treatments for leukoplakia, which have shown different results. However, the risk of malignant transformation is not completely eliminated by any of the current therapies. […] Initial treatment of a white oral lesion is the elimination of the possible aetiological factors: e.g. trauma, Candida, tobacco use etc. Complete and definitive cessation of tobacco is obligatory in patients with leukoplakia. […] Complete surgical removal (leaving free-lesion borders) is recommended in cases with epithelial dysplasia. In cases without epithelial dysplasia the decision concerning further treatment or not, is influenced by the extent and location of the lesion as well as the patient’s medical condition. […] Apart from surgical excision, other treatment modalities available include cryosurgery, laser surgery, retinoids, beta-carotene, bleomycin, calcipotriol, photodynamic therapy, etc. […] The major drawbacks for most current agents are the frequency of adverse effects and the recurrence of lesions when treatment is discontinued.

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