Protocolo de follow-up en leucoplasia proliferativa multifocal para evitar progresión maligna. Presentación de un caso clínico / Protocolo de acompanhamento em leucoplasia proliferativa multifocal para evitar progressão malignos. Apresentação de um caso clínico / Follow up protocol in proliferative multifocal leukoplakia to avoid malignant transformation. A case report

Resumen: La leucoplasia proliferativa multifocal (LPM) es considerada uno de los desórdenes potencialmente malignos (DPM) con mayor tasa de transformación carcinomatosa. La terapéutica es sumamente dificultosa ya que en la mayoría de los casos las lesiones son refractarias. El objetivo de este trabajo es presentar un caso de LPM y su evolución, destacando la importancia del seguimiento clínico mediante protocolos de follow up. Se presentó a la consulta una paciente de 75 años con múltiples lesiones queratóticas y verrugosas en toda la mucosa bucal y con un patrón de crecimiento proliferativo. Las biopsias y el contexto clínico permitieron encuadrarlo dentro del diagnóstico de LPM. La paciente adhirió a un protocolo estricto y hasta el momento se presenta libre de lesiones carcinomatosas. Este trabajo resalta el cuidadoso acompañamiento de los pacientes con este diagnóstico a fin de detectar precozmente carcinomas incipientes pudiendo mejorar el pronóstico de esta entidad.

Resumo: A leucoplasia proliferativa multifocal (LPM) é considerada um dos distúrbios orais potencialmente malignos (DOPM) com a maior taxa de transformação maligna. A terapêutica é extremamente difícil, pois na maioria dos casos as lesões são refratárias. O objetivo deste estudo é relatar um caso de LPM e sua evolução, destacando a importância do monitoramento clínico por meio de protocolos exaustivos de acompanhamento. Uma mulher de 75 anos com múltiplas lesões queratóticas e verrugas por toda a mucosa oral e com um padrão de crescimento proliferativo foi apresentada à consulta. As biópsias e o contexto clínico permitiram ajustá-lo ao diagnóstico de LPM. O paciente aderiu a um protocolo rigoroso e, até o momento, está livre de lesões carcinomatosas. Este trabalho destaca o acompanhamento cuidadoso dos pacientes com esse diagnóstico, a fim alcançar a detecção precoce do carcinoma epidermoide oral e, consequentemente, melhorar o prognóstico.

Abstract: Proliferative multifocal leukoplakia (PML) is considered one of the oral potentially malignant disorders (OPMD) with the highest malignant transformation rate. Therapeutics is extremely difficult since, in most cases, the lesions are refractory. This study aims to report a case of PML and its evolution, highlighting the importance of clinical monitoring through comprehensive follow-up protocols. A 75-year-old female with multiple keratotic and verrucous lesions with a proliferative growth pattern throughout the oral mucosa. The biopsies and the clinical context allowed clinicians to diagnose it as PML. The patient adhered to a strict protocol and so far has no carcinomatous lesions. This report highlights the careful monitoring of patients with PML to achieve early detection of oral squamous cell carcinoma and, consequently, improve prognosis.

Oral cancer on the gingiva in patients with proliferative leukoplakia: A study of 30 cases.

BACKGROUND: Proliferative verrucous leukoplakia, recently coined as proliferative leukoplakia (PL), is associated with a strong tendency to recur after treatment and an elevated rate of malignant transformation. We compared the clinical characteristics of patients with gingival PL with and without progression to oral squamous cell carcinoma. METHODS: The patients were divided into two groups: group 1 included 33 patients with gingival PL that did not progress to cancer, and group 2 included 30 patients with PL who developed malignant transformation during follow-up. We compared age, sex, tobacco habit, clinical characteristics of gingival PL lesions, and location, tumor-node-metastasis (TNM) stage, and clinical characteristics of gingival malignancy between groups. RESULTS: Female sex was predominant in the group with gingival cancer, and simultaneous involvement of the buccal mucosa, tongue, and palate was more common in this group than in the group without cancer. PL lesions were also largest in the group of patients with cancer. Most gingival cancer occurred in areas with teeth and took the form of oral ulceration. TNM stage I was most common. CONCLUSIONS: The simultaneous presence of lesions on the buccal mucosa, grade of lesion extension, and presence of ulcerative lesion were significantly associated with gingival cancer in patients with PL.