Sequential Management Of High-Risk Lingual Leukoplakia

This case demonstrates how risk-stratified protocols integrating surgical and optical technologies can optimize outcomes in high-risk oral leukoplakia (OLK) while minimizing morbidity. A 58-year-old non-smoking female presented with a 9-month history of lingual leukoplakia (1.0 × 0.5 × 1.0 cm) showing focal hyperplasia. Clinical risk stratification classified her as high-risk for malignant transformation. Initial management involved sharp cusp adjustment and surgical excision, with histopathology confirming mild-to-focal severe epithelial dysplasia. The patient underwent quarterly surveillance using autofluorescence imaging and DNA quantitative cytology. At the 6-month follow-up, a 0.1 × 0.2 × 0.2 cm recurrence was detected and successfully treated with photodynamic therapy (PDT), with no further recurrence observed at 12 months. Risk-adapted management is crucial for OLK patients, particularly those with ≥2 risk factors (e.g., age >50 years, female sex, tongue location, and dysplasia). The proper functioning of OLK clinical management requires joint implementation by both clinicians and patients. Multimodal monitoring enabled early detection of recurrence at one-tenth the original size, permitting conservative treatment. Sequential therapy combining: 1.the risk assessment model developed by our research team, 2.mechanical irritant removal, 3.surgical excision for definitive diagnosis, 4.autofluorescence/cellular DNA quantitative analysis for surveillance, and 5.PDT for minimal recurrence proved effective in tracking disease progression, enabling timely intervention, and reducing the malignant transformation rate of OLK.