Treatment of "ring around the collar" and other gingival leukoplakias with high-power diode laser: A single-center case series.

Abstract

Background: Oral leukoplakia is the most common oral potentially malignant disorder. Currently, there is still no consensus on the best approach for its treatment. Marginal gingival cases ("ring around the collar") can pose an additional challenge for treatment, being associated with high recurrence rates. This case series report 10 patients with "ring around the collar" lesions treated with diode laser excision in a single center.

Methods: Ten patients diagnosed with marginal gingival leukoplakia were treated with high-power diode laser excision. The demographic data were extracted from the medical charts and the patients were followed up every 3 months after treatment.

Results: Of the 10 patients, three were men and seven were women, with a mean age of 64.4 years. Five had a history of tobacco smoking and one reported alcohol consumption. Eight had multifocal lesions, with all of them being homogeneous. Eight cases were diagnosed as proliferative verrucous leukoplakia and two had previously undergone treatment for gingival squamous cell carcinoma. Postoperative complications were limited to mild pain within the first week. During an average follow-up of 27.4 months, seven patients experienced recurrence, occurring after a mean of 8.6 months, with smaller, homogeneous, and clinically less aggressive lesions. No malignant transformation was observed.

Conclusions: Marginal gingival leukoplakias, often associated with proliferative verrucous leukoplakia, are challenging to manage due to their high recurrence rates and malignant transformation risk. This case series suggests that high-power diode laser excision may offer better lesion control while minimizing gingival recession. However, further research is necessary to improve knowledge of this entity.

Key points: Marginal gingival leukoplakias, especially the "ring around the collar" type, are relatively uncommon, but can show an aggressive nature, being associated with high recurrence rates. Removing these lesions with a high-power diode laser, even with the chance of recurrence, may be a better option than more aggressive modalities. This method helps control recurring lesions and might reduce the chances of gingival recession.

Plain language summary: This case series suggests that removing these lesions with a high-power diode laser, even with the chance of recurrence, may be a better option than more aggressive modalities. This method helps control recurring lesions and might reduce the chances of gingival recession.