Management of Oral Leukoplakia

Diagnosis and Risk Assessment

Oral leukoplakia is defined as a predominantly white patch or plaque of the oral mucosa that cannot be wiped away and is not clinically or histologically characterized as any other definable disorder 1, 2

ALA-PDT has emerged as the fourth alternative therapeutic approach after chemotherapy, surgery, and CO2 laser ablation/cryosurgery 3
The International journal of oral science recommends ALA-PDT as the preferred treatment for oral leukoplakia, particularly for extensive lesions or those located in areas with underlying functional structures, due to its minimally invasive nature, efficacy, and low risk of systemic side effects and disfigurement 1, 2
Benefits of ALA-PDT include its minimally invasive nature 2, low risk of systemic side effects 2, and minimal disfigurement 1
ALA-PDT is particularly valuable for treating lesions in regions with underlying functional structures 1
Observation without intervention is a non-surgical approach 2
Cryosurgery is a surgical approach with limitations, including postoperative pain, edema, and scarring 2

Preparation involves dissolving ALA to yield a 20% aqueous solution immediately before use 4
Treatment parameters include using a semiconductor laser light source at 630 nm ± 5 nm 4, a power of 100 mW•cm−2 4, and a total light exposure dose of 100 J•cm−2 4
Post-treatment care includes keeping the mouth clean 4 and preventing exposure of the treated area to light for at least 48 hours 4

Common adverse reactions include mild to moderate pain, hyperemia, edema, erosion, ulceration, and bleeding 3
For severe cases, treatment options include 0.1% chlorhexidine gargling solution 4, topical glucocorticoid preparations 3, and compound benzocaine gel for severe pain 3

Studies with standardized parameters and protocols, as well as randomized clinical trials with adequate sample sizes and long-term follow-up, are needed 3

Photodynamic therapy (ALA-PDT) has emerged as an alternative therapeutic approach for managing oral leukoplakia, especially for lesions in regions with underlying functional structures where surgical methods may be less feasible 5, 6
Traditional treatment approaches include non-surgical (chemoprevention or observation) and surgical methods (traditional excision, electrocauterization, CO2 laser ablation, and cryosurgery) 5, 7