Surgical excision and follow-up of nondysplastic oral leukoplakia. A systematic review

In this systematic review, we aimed to clarify the clinical question, “Should nondysplastic oral leukoplakia be surgically excised?”, in accordance with the Japanese Oral Cancer Clinical Practice Guidelines. We searched MEDLINE, Japana Centra Revuo Medicina Web, and the Cochrane Central Register of Controlled Trials to identify articles that met the pre-established criteria. We performed a statistical analysis using RevMan Web and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. In total, 784 articles were identified, and one randomized controlled trial including 235 participants was selected. The only primary outcome that could be assessed was rate of malignant transformation, with a risk ratio of 1.14 and a 95 % confidence interval of 0.07–17.95. Meta-analysis was not performed because only one randomized controlled trial was available. The time to onset of malignant transformation, rate of recurrence, rate of clinical resolution, and rate of clinical deterioration were not analyzed due to the lack of data. The certainty of the evidence was very low. We could not determine the superiority of surgical excision over follow-up in patients with non-dysplastic oral leukoplakia. Future multicenter data collection, utilizing standardized and objective measures, is essential to better define the indications for surgical excision in patients with non-dysplastic oral leukoplakia.