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Leukoplakia initial management
- Single/multiple foci - completely excised if possible.
- Widespread/confluent - mapped & multiple biopsies & staged resection if feasable. low threshold rebiopsy.
All biopsies mounted
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Treatment modality
- Either
- Cold steel
- Laser - CO2, ablation discouraged
- Radiotherapy - rarely, poor access in high grade
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Grading
- WHO - squamous hyperplasia,mild,mod,severe dysplasia, ca insitu
- Ljubliana - squamous cell (simple) hyperplasia, basal/parabasal cell hyperplasia,atypical hyperplasia, carcinoma in-situ
- severe dysplasia . atypical hyperplasia and carcinoma in situ - discuss MDT
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Decision to treat
- 10-20% risk of malignant tranformation
- =atypical hyperplasia, severe dysplasia orcarcinoma in situ
- dysplasia at surgical margins is notconsidered to be an indication for further excision orbiopsy
- Lesions that subsequently recur or change inappearance warrant further investigation.
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Risk classification
- High risk1. severe dysplasia or carcinoma insitu or
- 2. mild/moderate dysplasia with i Continued smoking.ii. persistent hoarseness.or iii lesion visible on endoscopy.
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Follow up
- Low risk general ENT surgeons, minimum 6 month
- High risk - Head & Neck clinic, as for T1
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Persistent/recurrent lesions
- Focal mild/moderate - excisied if possible
- Widespread mild/moderate - excsion or observation
- Focal severe - treat as T1, excise, radiotherapy if access problems, continued smoking, preference,2+ recurrences
- Widespread severe - radiotherapy esp if cont smoking
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