Clinical Outcomes of Diode Laser Ablation Versus Diode Laser Excision in the Management of Oral Leukoplakia: An Observational Study

Background: Oral leukoplakia is the most common potentially malignant disorder of the oral mucosa (OM). Although diode laser therapy offers a minimally invasive alternative to conventional scalpel excision, the comparative clinical outcomes of diode laser ablation and diode laser excision remain inadequately characterized, particularly regarding postoperative recovery and recurrence risk. Materials and methods: This prospective comparative observational study included 60 patients with histopathologically confirmed homogeneous oral leukoplakia who underwent diode laser ablation (n = 30) or diode laser excision (n = 30) based on the surgeon's clinical decision. Postoperative outcomes, including wound healing, pain, bleeding, and swelling, were assessed at one, three, and five weeks. Recurrence and functional disturbances were assessed at the six-month follow-up. A three-way mixed repeated-measures ANOVA was used to analyze longitudinal changes in wound healing, pain, bleeding, and swelling according to treatment modality, dysplasia grade, and follow-up time, whereas chi-square tests were used to compare recurrence and functional outcomes. Results: Laser ablation demonstrated significantly superior early postoperative outcomes compared to excision at weeks 1 and 3 across all parameters, including healing, pain, bleeding, and swelling (all p < 0.001), regardless of dysplasia grade. By week 5, wound healing, pain, and swelling were comparable between the treatment groups except bleeding. Dysplasia grade significantly influenced healing (p = 0.004) but not other parameters. Importantly, the overall recurrence rate was significantly higher after ablation than that after excision (26.7% vs. 6.7%, p = 0.038), with the most pronounced difference observed in the mild dysplasia subgroup (46.7% vs. 0.0%, p = 0.006). Conclusions: Diode laser ablation offers superior early postoperative recovery with reduced pain, bleeding, swelling, and accelerated healing compared to excision. However, this short-term benefit is offset by significantly higher recurrence rates, particularly in lesions with mild dysplasia. These findings suggest that a dysplasia-stratified treatment approach may be considered for the management of homogeneous oral leukoplakia. Based on the findings of the present observational study, laser ablation may offer advantages for non-dysplastic lesions, whereas laser excision may reduce recurrence in lesions with mild epithelial dysplasia.