Oral Leukoplakia:
🔹 Core principle: Management is risk-based, guided by clinical appearance, site, and histology. Main aim is to reduce malignant transformation risk, but no treatment completely eliminates recurrence or cancer risk.
🔹 Risk-factor removal: Stop tobacco/betel, reduce alcohol, and treat local irritation or candidiasis.
🔹 Observation: Appropriate for low-risk, nondysplastic lesions, with close long-term follow-up.
🔹 Surgical excision / laser excision: Preferred for moderate-to-severe dysplasia and high-risk lesions. Surgery is still the most accepted definitive treatment.
🔹 Laser ablation / cryosurgery: Can be used in selected cases, but are less preferred when histologic margin assessment is important.
🔹 Topical imiquimod 5%: A promising off-label emerging option. Recent retrospective studies show lesion reduction in many patients, though temporary adverse effects can occur.
🔹 Photodynamic therapy (PDT): Especially 5-ALA–mediated PDT, has shown encouraging short-term clinical response with few side effects.
🔹 Immunotherapy: Nivolumab is being explored as an investigational option in high-risk leukoplakia, especially proliferative verrucous leukoplakia.
🔹 Antioxidants / chemoprevention: Lycopene, curcumin, and vitamin-based therapies are still under study, but evidence remains inconsistent.
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