Laryngeal leukoplakia

Introduction:

The term laryngeal leukoplakia was first introduced by Pierce in 1920. Gnepp used the term laryngeal keratosis to describe the same condition. Leukoplakia is a Greek terminology to indicate “white plaque”. Laryngeal leukoplakia indicates presence of keratin on the epithelial surface. The presence of keratin on the vocal cord is pathologic because it is lined by non keratinizing squamous epithelium. Studies have shown that leukoplakia to be in the spectrum of the transformation of laryngeal epithelium towards malignancy. It was Jackson who suggested that leukoplakia of larynx is the precursor of laryngeal cancer.

Etiology of laryngeal leukoplakia:

1. Smoking

2. Industrial pollution

3. Alcoholism

4. Laryngopharyngeal reflux

Histopathologically leukoplakia has been classified into:

1. Normal (no dysplasia) – Periodical observation of the patient is a must

2. Dysplastic – Premalignant condition hence surgery should be resorted to. Irradiation will accentuate malignant transformation.

3. Malignant

Presence of dysplasia in the laryngeal leukoplakia is an indication of potential for malignant transformation. It is this group of patients who should be carefully monitored and followed up on a regular basis. Earlier the age of development of leukoplakia better are the chances of malignant transformation.

Management:

Other than keeping a close watch by performing repeated biopsies from the lesion nothing more is necessary. Avoidance of carcinogens like tobacco / alcohol is a must. Recently 585 nm pulsed dye laser have been found useful in the management of these lesions. Celecoxib and topical retinoic acid administration has been tried with varying success rates.