University of California, Department of Stomatology, School of Dentistry, San Francisco, California.
Objectives/Hypothesis: To assess the efficacy of laser therapy for the management of premalignant oral lesions. Study Design: The study group consisted of seventy consecutive laser-treated patients with oral leukoplakia. The microscopic diagnosis included idiopathic focal keratosis, dysplasias of all grades, and verrucous hyperplasia (proliferative verrucous leukoplakia). Thirty-nine patients had some degree of microscopic dysplasia and six demonstrated high-risk proliferative verrucous leukoplakia. The clinical appearances of the lesions were white (homogeneous leukoplakia) in 48, red and white (erythroleukoplakia) in 8, and verrucous in 14. There were 38 men and 32 women in this group. The average age was 63 years (range, 31–90 y). Methods: Lasers employed were the CO2 and Nd:YAG lasers, and standard laser safety protocols were used. Results: There was no postoperative infection, hemorrhage, or paresthesia. Two patients developed pyogenic granulomas in their surgical sites. Fifty-five of 70 patients were followed for more than 6 months; follow-up averaged 32 months (range 6–178 mo). Twenty-nine patients had complete control of their lesions; 19 patients had small recurrences removed with subsequent laser surgeries, leading to control; 2 patients had complete recurrences; and 5 patients developed squamous cell carcinoma at the lesion site. Verrucous lesions had an especially high rate of recurrence (83%), with 9 of 12 ultimately controlled with subsequent surgeries. Conclusions: Laser surgery of oral leukoplakia is an effective tool in a complete management strategy that includes careful clinical follow-up, patient education to eliminate risk factors and report suspicious lesions, and biopsy of suspicious lesions when appropriate. However, recurrence and progression to cancer remain a risk. Key Words: oral cancer, laser, CO2, Nd:YAG, leukoplakia.