Clinical Management Update of Oral Leukoplakia - A Review From the American Head and Neck Society Cancer Prevention Service

Sep 21, 2026

Uploaded by Theodora

Oral potentially malignant disorders (OPMDs) affect up to 4%–5% of the population, with oral leukoplakia (OL) as the most common subtype; identifying which cases carry high malignant transformation risk remains difficult. Early detection and effective management are emphasized to improve outcomes. Clinical updates summarize evidence from 2015 to present, highlighting large patient cohorts for risk counseling, and covering surveillance, excision, laser surgery, plus local and systemic chemoprevention. Promising biomarkers and diagnostic adjuncts are noted but require further validation.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Introduction

OPMD classification, prevalence, and malignant transformation risk

Methods

Literature search strategy (2015 to present)

Results

Evidence from recent patient cohorts

Clinical management options: surveillance, excision, laser surgery, chemoprevention

Emerging biomarkers and diagnostic adjuncts

Conclusion

Head & Neck CLINICAL REVIEW OPEN ACCESS Clinical Management Update of Oral Leukoplakia: AReview From the American Head and Neck Society Cancer Prevention Service James C. Gates1 | Marianne Abouyared2 | Yelizaveta Shnayder3 | D. Gregory Farwell4 | Andrew Day5 | Faizan Alawi6 | Michael Moore7 | Andrew J. Holcomb8 | Andrew Birkeland9 | Joel Epstein10,11 1Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA | 2Department of Otolaryngology—Head and Neck Surgery, UC Davis Health, Sacramento, California, USA | 3Department of Otolaryngology—Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA | 4Department of Otorhinolaryngology—Head and Neck Surgery, Hospital of the University of Pennsylvania and Perelman School of Medicine, Philadelphia, Pennsylvania, USA | 5Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas, USA | 6Department of Oral and Maxillofacial Pathology, Penn Dental Medicine and Department of Cutaneous Biology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA | 7Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA | 8Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA | 9Department of Otolaryngology-Head and Neck Surgery, UC Davis Health, Sacramento, California, USA | 10Department of Surgery, Cedars-Sinai Health System, Los Angeles, California, USA | 11City of Hope Comprehensive Cancer Center, Duarte, California, USA Correspondence: James C. Gates ([james.gates@pennmedicine.upenn.edu](james.gates@pennmedicine.upenn.edu)) Received: 21 September 2024 | Revised: 8 November 2024 | Accepted: 13 November 2024 Funding: The authors received no specific funding for this work. Keywords: dysplasia | oral cancer | oral carcinogenesis | oral leukoplakia | oral premalignant disease ABSTRACT Background: Oral potentially malignant disorders (OPMDs) occur in up to 4%–5% of the population, of which oral leukoplakia (OL) is the most common subtype. Predicting high-risk OL remains a challenge. Early diagnosis and effective treatment are thought to be of paramount importance to improve outcomes. Methods: We searched PubMed and Clinicaltrials.gov data for updates in the clinical management of OL from 2015 to current. Results: Recent publication of large cohorts of patients with OL aids in counseling patients regarding risk of malignant transformation. Management for OL includes surveillance, excision, and laser surgery, as well as local and systemic approaches to chemoprevention. Several new entities show promise regarding candidate biomarkers, chemoprevention agents, and diagnostic adjuncts, though all require further validation. Conclusion: This update serves to further inform clinical management of OL and provide impetus for future investigations. Trial Registration: NCT00099021, NCT00951379, NCT05727761, NCT05727761 1 | Introduction The World Health Organization (WHO) maintains the classification of diseases that constitute “oral potentially malignant disorders”(OPMDs) [1]. The worldwide prevalence of OPMDs is 4.5%, and the most common type is oral leukoplakia (OL), which has an estimated prevalence of 1.39% worldwide and up to 9.10% in specific populations [2–4]. A recent meta-analysis reported an overall malignant transformation (MT) rate for OL of 9.5%[5]. Populationlevel data are predominately derived from studies outside the United States (US), so there is further uncertainty about prevalence ofOL and OPMDs more broadly within the United States. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2024 The Author(s). Head & Neck published by Wiley Per

FAQs

Why is clinical management of oral leukoplakia challenging?

High-risk cases are difficult to predict because malignant transformation risk is not straightforward to assess from clinical features alone. Early diagnosis and effective treatment are emphasized to improve outcomes.

What management approaches are covered for oral leukoplakia?

Management includes surveillance, excision, and laser surgery, along with local and systemic approaches to chemoprevention. The review also discusses how recent evidence can support patient counseling.

What areas are described as promising but needing further validation?

Several new entities show promise as candidate biomarkers, chemoprevention agents, and diagnostic adjuncts. All are noted to require further validation before routine use.

Sep 21, 2026

Uploaded by Theodora