Verrucous Proliferative Leukoplakia is a rare aggressive form of leukoplakia characterized by high tendency of malignant transformation. It is often seen in females over 60yrs often associated to tobacco. Its histological aspect may vary from simple hyperkeratosis to various degrees of dysplasia sometimes mimicking Verrucous Carcinoma. The treatment is surgical but the VPLs show high recurrence rates independently by surgical approach. Recently a non surgical and non invasive treatment of these lesions was suggested, based on photochemical light induced reaction (Photodynamical Therapy/PDT), permitting safe and complete removal of pathologic tissue respecting the nearby healthy one. A case of PDT treatment of a VPL is presented with follow up at 18 months. The patient is a 84yrs non smoker female, presenting a wide asymptomatic white verrucous patch on the right cheek. An incisional scalpel biopsy was early performed to exclude any sign of dysplasia; the diagnosis was of VPL. The PDT was performed by sub-ministration of the photosensitizer, 5-Aminolaevulinic Acid (5-ALA) in 20% oral gel, 90′ before laser exposure. The laser adopted was a 635nm diode (Lambda Spa, Vicenza, Italy). The irradiation was performed twice a week, each second day. The protocol previewed a maximum of 6 applications, less in case of clinical disappearance of the lesion. Laser power was 100mW, in CW with scanning no contact movement and total energy of 100mJ. The exposure time was 1000 seconds, in 5 cycles of 3′, with intervals of 3′ to permit the synthesis of the Protoporphirin IX, and a final cycle of 100 seconds. After 5 applications the lesion totally disappeared, without side effects scarring or pain both in immediate and follow up period. Controls were scheduled each 3 months; at 18 months no recurrence was observed. In this case the PDT resulted very helpful in the management of VPL. More studies and cases are needed to evaluate its real efficacy for the treatment of these lesions.
References
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