# Proliferative verrucous leukoplakia management requires x-ray surveillance. A retrospective study of 78 cases

## TL;DR

This study shows that X-ray imaging is crucial for managing a rare oral condition called PVL, as it helps detect bone loss and early signs of cancer.

## Contribution

The study introduces the importance of radiographic surveillance in PVL management for detecting bone resorption and early malignant transformation.

## Key findings

- A correlation between alveolar bone resorption and PVL lesions was found in 66.7% of cases.
- Oral squamous cell carcinoma developed in 37% of PVL cases.
- Radiographic follow-ups helped detect malignant transformation in 17% of cancer cases before clinical signs appeared.

## Abstract

Proliferative verrucous leukoplakia (PVL) is a very rare lesion of the oral mucosa with frequent development of oral epithelial dysplasia and a very high ratio of malignant transformation (MT). The aim of this study is to correlate radiographic assessment of alveolar bone resorption with the clinical manifestations and course of PVL in order to improve therapy.

The study evaluates the resorptive changes on alveolar ridges in 78 cases of PVL, confirmed by clinical and pathological criteria. All patients were treated at the Oral Medicine Department, Dentistry Clinic, University Hospital Pilsen. Each case was examined for bone defects using imaging methods such as X-ray intraoral scans, orthopantomograms, or cone beam computed tomography (CBCT). The location and extent of the resorption were correlated with the distribution of PVL lesions in the oral cavity and the course of the mucosal disease. Cases with MT underwent whole-body examination using hybrid imaging techniques, including positron emission tomography (PET) combined with either magnetic resonance imaging (MRI) or computed tomography (CT).

A correlation between the alveolar resorptive process and the development of PVL lesions was found in 66.7% of PVL cases (52/78). In one-sixth of cases (13/78), progressive bone loss paralleled worsening mucosal status and increased tooth mobility. Radiographic follow-ups delineated areas indicated for antimicrobial and anti-inflammatory therapy to address aggressive local cofactors in PVL. Oral squamous cell carcinoma developed in 37% of cases (29/78). Combined clinical and radiologic surveillance enabled early detection of malignant transformation (MT) in 5 cases (17% of MTs).

Routine radiologic assessment is an essential component of PVL management. Radiography and CT improve detection of local cofactors, help define the scope of therapy, and may indicate the onset of MT before overt clinical manifestations.

The online version contains supplementary material available at 10.1007/s00784-026-06815-w.