Wednesday, July 29, 2020

Marginal linear gingival leukoplakia progressing to “Ring around the collar” – An ominous sign of Proliferative verrucous leukoplakia

Abstract

Background

Potentially malignant lesions of the gingiva may frequently present as well‐demarcated white lesions confined to the marginal gingiva. These lesions often become thick and verrucoid and spread along the marginal gingiva to encircle the tooth. Some cases of marginal gingival leukoplakia, over time, progress to extensively involve the gingiva fulfilling the criteria for proliferative verrucous leukoplakia (PVL). The objective of this study is to raise awareness of this pattern of leukoplakia by reporting a series of cases of marginal gingival leukoplakia.

Methods

An IRB approved retrospective search of UF and UNMC oral biopsy services was performed for all gingival biopsies. Inclusion criteria included cases (a) exhibiting marginal gingival leukoplakia, and (b) with accompanying clinical images.

Results

A total of 30 cases of marginal gingival leukoplakia were included. All cases presented as well‐demarcated leukoplakias, either on the buccal or lingual gingival margin, or circumferentially forming a “ring around the collar” of single or multiple teeth. Eight patients had recurrent lesions and twelve had multifocal involvement. Six of the 12 patients with multifocal involvement presented with a “ring around the collar”. The histopathologic diagnoses were representative of benign lesions in 7 cases, premalignant in 13, and malignant or suggestive of malignancy in 10 cases. Seven patients had carcinoma at the time of first biopsy, whereas 6 cases showed progression at time of follow‐up.

Conclusion

This study aims to raise awareness that marginal gingival leukoplakia may represent potentially malignant lesions, and if circumferential and/or thick, may be the first manifestation of PVL.

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from
https://aap.onlinelibrary.wiley.com/doi/abs/10.1002/JPER.19-0621?af=R

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