Treatment experience with and clinicopathological analysis of vocal fold leukoplakia per appearance classification guidance: a cohort of 1442 patients

OBJECTIVE

To analyse the comparative clinical outcomes and clinicopathological significance of vocal fold leukoplakia lesions treated by appearance classification and traditional methods.

METHOD

A total of 1442 vocal fold leukoplakia patients were enrolled. Group A patients were treated according to appearance classification and Group B patients were treated according to traditional methods.

RESULTS

In Group A, 24.4, 14.9 and 60.6 per cent of patients had grade I, II and III dysplasia, respectively. Grade I dysplasia (63.4 per cent) was more than twice as frequent in Group B patients than in Group A patients, while grade II dysplasia (20.4 per cent) and grade III dysplasia (16.2 per cent) were significantly less frequent in Group B patients than in Group A patients (p = 0.000). There was a significant correlation between vocal fold leukoplakia appearance and the degree of dysplasia (p = 0.000). The recurrence and malignant transformation rates (17.6 and 31 per cent, respectively) in Group B were significantly greater than those in Group A (10.8 and 25.9 per cent, respectively) (p = 0.000).

CONCLUSION

Vocal fold leukoplakia appearance classification is useful for guiding treatment decision-making and could help to improve therapeutic accuracy.

Analysis of prognostic factors for vocal fold leukoplakia based on 344 cases at a two-year follow up

OBJECTIVE

To evaluate risk factors for poor prognosis in vocal fold leukoplakia.

METHODS

Clinical data were collected for 344 patients with vocal fold leukoplakia who received surgical treatment in our otolaryngology department from October 2010 to June 2019. Univariate and multivariate logistic regression analyses of the relevant factors were conducted.

RESULTS

Among the 344 patients, 98 exhibited recurrence and 30 underwent a malignant change. Multivariate logistic regression analysis showed that size of the lesion (p = 0.03, odds ratio = 2.14), form of the lesion under white light (p < 0.001), surgical method (p < 0.001, odds ratio = 0.28) and pathological type (p < 0.001) were independent factors that affected the recurrence of vocal fold leukoplakia. In both univariate and multivariate analyses, the sole independent risk factor for malignant transformation of vocal fold leukoplakia was pathological type (p < 0.001).

CONCLUSION

The outlook for vocal fold leukoplakia depends on several clinical factors, especially pathological type. The more severe the pathological type, the more likely it is to recur or become cancerous.

Feasibility of transnasal flexible carbon dioxide laser surgery for laryngopharyngeal lesions

OBJECTIVE

The fiber-guided carbon dioxide (CO₂) laser is a useful device for laryngopharyngeal surgery. The flexible CO₂ wave-guide laser has been developed and commercially available for several years. However, the transnasal use of CO₂ flexible wave-guided laser surgery through the instrument channel of a flexible endoscope (CO₂ TNFLS) is not permitted in Japan. This feasibility study aimed to assess the value and the safety of an in-office CO₂ TNFLS procedure.

METHODS

Patients with small laryngopharyngeal diseases were enrolled from June 2015. Eligible patients had indications with lesions generally localized superficial lesions such as the benign tumor, leukoplakia, and premalignant lesion-like carcinoma in situ (CIS). Patients were locally well anesthetized using xylocaine. After removing as much of the lesion(s) as possible with flexible forceps, the remainder of the lesions were evaporated using CO₂ TNFLS through the instrument channel of a flexible endoscope under local anesthesia.

RESULTS

Eighteen surgeries involving 13 patients, including 9 papilloma (7 recurrent respiratory papilloma [RRP]), 2 carcinoma in situ, 1 leukoplakia, and 1 large epiglottic cyst), were performed. Four patients with RRP required multiple surgeries. Except for 3 patients with RRP, all patients achieved disease control without additional intervention. All procedures were completed with no severe adverse events.

CONCLUSION

Office-based CO₂ TNFLS is safe and feasible for patients with laryngopharyngeal pathologies. It is especially valuable for RRP patients with small lesions to avoid surgery under general anesthesia.

Clinicopathological parameters associated with histological background and recurrence after surgical intervention of vocal cord leukoplakia

Histological examination of biopsy shows usefulness in the diagnosis of vocal cord leukoplakia; however, in considerable amount of cases, the examination cannot provide definitive diagnosis of malignancy from benign conditions such as hyperplasia and dysplasia. The present work therefore was aimed to identify clinicopathological factors and molecular markers predictive of recurrence and malignant transformation of vocal cord leukoplakia.Clinical data of 555 cases of vocal cord leukoplakia enrolled from July 1999 to June 2014 were analyzed. The cohort consisted of keratosis (n = 137), hyperplasia (n = 139), dysplasia (n = 177), and primary (n = 10) and invasive (n = 46) carcinoma. Correlations between patients' backgrounds, clinicopathological factors, molecular markers (p53, p16, Ki67, cytokeratin, and proliferating cell nuclear antigen), and histology backgrounds were examined using by Pearson Chi-squared or Fisher exact test. Reflux symptom index (RSI) and reflux finding score (RFS) before and after treatment were compared using Wilcoxon signed-rank test. Risk factors for disease recurrence were identified using Cox proportional hazards models of multivariate analysis. Time to recurrence was analyzed using log-rank test of Kaplan-Meier method.In the present cohort, alcohol drinking was found associated with GRBAS grade (P = .0258) and the site (P = .0298) of leukoplakia. For the different disease types, chief complaint (P = .0179), GRBAS grade (P = .0101), mucosal wave (P < .0001), and molecular markers p53 (P < .0001) and Ki67 (P < .0001) were identified as correlates. RSI and RFS were significantly lowered by surgical intervention. A single side of leukoplakia was predictive of a lower risk of recurrence (odds ratio, 0.378; 95% confidence interval, 0.197-0.723; P = .0033). Absence of mucosal wave was associated with a shorter time-to-recurrence (P = .0357).The present work identified clinicopathological factors and molecular markers associated with the different histology of vocal cord leukoplakia, and also the prognostic factor for the low risk of recurrence after surgery.

Practice variations in voice treatment selection following vocal fold mucosal resection

OBJECTIVES/HYPOTHESIS

To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population.

STUDY DESIGN

Retrospective analysis of a large, nationally representative Medicare claims database.

METHODS

Patients with > 12 months of continuous Medicare coverage who underwent a leukoplakia- or cancer-related vocal fold mucosal resection (index) procedure during calendar years 2004 to 2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each postindex treatment type, treating the other treatment types as competing risks, and further evaluated postindex treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex, and Medicaid eligibility were used as predictors.

RESULTS

A total of 2,041 patients underwent 2,427 index procedures during the study period. In 14% of cases, an initial voice treatment event was identified. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65 to 75 years, the likelihood of undergoing surgical treatment increased significantly with each 5-year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy.

CONCLUSION

The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age, and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care.

LEVEL OF EVIDENCE

2c. Laryngoscope, 126:2505-2512, 2016.

Office-Based Laryngeal Laser Surgery: A Review of 443 Cases Using Three Wavelengths

BACKGROUND: Unsedated office-based laser surgery (UOLS) of the larynx and trachea has significantly improved the treatment options for patients with laryngotracheal pathology including recurrent respiratory papillomas, granulomas, leukoplakia, and polypoid degeneration. UOLS delivered by flexible endoscopes has dramatically impacted office-based surgery by reducing the time, costs, and morbidity of surgery.

OBJECTIVES: To review our experience with 443 laryngotracheal cases treated by UOLS.

METHODS: The laser logbooks at the Center for Voice and Swallowing Disorders were reviewed for UOLS, and the medical and laryngological histories were detailed, as were the treatment modalities, frequencies, and complications.

RESULTS: Of the 443 cases, 406 were performed with the pulsed-dye laser, 10 with the carbon-dioxide laser, and 27 with the thulium: yttrium-aluminum-garnet laser. There were no significant complications in this series. A review of indications and wavelength selection criteria is presented.

CONCLUSION: Unsedated, office-based, upper aerodigestive tract laser surgery appears to be a safe and effective treatment option for many patients with laryngotracheal pathology.

Clinical classification and treatment of leukokeratosis of the vocal cords

BACKGROUND

Leukokeratosis of the vocal cords is a clinical descriptive diagnosis, which includes a group of squamous intraepithelial lesions of the vocal cord mucosa. We investigated the clinical classification and treatment efficacy of leukokeratosis of the vocal cords.

METHODS

We conducted a retrospective analysis of the medical history, laryngoscopic examinations, morphological features under a surgical microscope, and pathology results of 360 cases of leukokeratosis of the vocal cords to examine correlations among treatment modalities, therapeutic effects, and clinical features.

RESULTS

All cases were divided into four types based on symptoms, examination results, and treatment efficacies as follows: 21 patients had type I inflammatory leukoplakia and their vocal cord morphology and voice quality recovered after conservative therapies; 76 patients had type II frictional polyps and received CO2 laser submucosal cordectomy; 68 patients had type III sulcus vocalis and received mucosal slicing with dredging; and 195 cases had type IV simple leukokeratosis and received partial subligamental cordectomy with CO2 lasers or transmuscular cordectomy. Our treatment achieved a surgical cure rate of 90.9% (308/339), with a recurrence rate of 9.1% (31/339) and malignant transformation rate of 6.5% (22/339). All cancerous transformations occurred in type IV patients.

CONCLUSION

Choosing conservative or CO2 laser surgery based on the morphological characteristics of squamous epithelial lesions of keratinized vocal cord mucosa can maximally protect voice quality, reduce complications, and improve the cure rate.

[Clinical classification and management of squamous intraepithelial lesions of the vocal cord]

OBJECTIVE

To discuss the clinical classification of the squamous intraepithelial lesions (SILs) of vocal cord and their outcomes after different therapeutic procedures.

METHODS

Three hundred and forty-three patients with the SILs of vocal cord were enrolled. Based on the history of the diseases, macroscopic appearance by video rhino aryngoscopic, stroboscopic and microlaryngoscopic examination, and pathological findings, the correlation of clinical features, treatment modalities and treatment effect of the vocal cord SILs were discussed.

RESULTS

According to the morphological characteristics, 343 patients were divided into four types. TypeI, leukoplakia combined with inflammation (n = 19); type II, leukoplakia combined with polyps by friction (n = 72); type III, leukoplakia combined with sulcus vocalis (n = 64); type IV, keratosis (n = 188). Patients with type I lesions were treated by medications. The vocal cord configuration and the voice of the patients in type I returned to normal after treatment. Patients with type II, III, IV lesions were treated by CO(2) laser. Type II were treated by subepithelial cordectomy, type III by mucosa slicing with dredging, type IV by sub ligament cordectomy or trans muscular cordectomy. The cure rate of patients with type II, III, IV lesions was 90.7% (294/324) after single surgery, the recurrent rate was 9.3% (30/324). Twenty-one patients (11.2%), all in type IV, developed carcinogenesis. Eight cases were diagnosed in the first surgery and 13 cases in the second. Among the 13 cases diagnosed in the second surgery, 2 cases had partial laryngectomy for the third surgery.

CONCLUSIONS

Since the squamous intraepithelial lesions of vocal cord manifested differently, conservative treatment or CO(2) laser surgery should be used. In this way, a less invasive procedure, better recovery of the voice and less complication could be expected.

A multiple primary carcinoma consisting of leukoplakia and SCC: a case report with p53 mutation analysis

Patients with an oral squamous cell carcinoma (OSCC) often develop multiple malignant lesions. This report examined whether individual tumours developed in a patient show the same genetic alteration, such as p53 mutations. This case study describes three SCCs and three leukoplakias which developed simultaneously in a single 67-year-old Japanese man. A p53 mutation was detected in two of the three SCCs and one of the three leukoplakias. One SCC had a missense mutation at codon 285 (GAG>AAG, Glu>Lys) and the other a nonsense mutation at codon 336, and the leukoplakia had a missense mutation at codon 273 (CGT>CAT, Arg>His). This case showed that individual oral tumours may have different genetic changes even when they develop in a single patient. Therefore, this report provided strong evidence that in cases of multiple tumours it is necessary to design tailor-made therapies for each individual tumour rather than a single standardised therapy for all multiple tumours.

[Clinic and pathological analysis the larynx leukoplakia in 74 cases]

OBJECTIVE

To study the clinic and pathological features of leukoplakia of the larynx, and reduce canceration rate.

METHOD

Seventy-four postoperative patients of leukoplakia of the larynx were followed up for four years by telephone or clinic service.

RESULT

None of eighteen cases of pure leukoplakia was recurrence. Fifty-six cases were leukoplakia with epithelial dysplasia histologically. Seven out of fifty-six postoperative cases occurred hoarseness; three out of fifty-six postoperative cases recurred, and accepted twice or more operations successively; three out of fifty-six postoperative cases occurred canceration.

CONCLUSION

Operation is the main means for the treatment of leukoplakia of the larynx, and the effect is comparatively well. The patients with histological epithelial dysplasia should be pay great attention because of their higher canceration rate, and enlarged operation ranges appropriately with the patient consent could effectually prevent recurrence or canceration during the early lesions. Close observation is important for these patients.

[Endoscopic chromoscopy in diagnosing and treatment of complicated gastroesophageal reflux disease]

The authors describe the results of examination and endoscopic treatment of 278 patients with clinical symptoms of gastroesophageal reflux disease. The method of fibroesophagoduodenoscopy with 3% Lugol aqueous solution chromoscopy was introduced in medical-diagnostic algorithm of the patients. Inclusion of chromoendoscopy in the program of examination and treatment of patients with gastroesophageal reflux disease allowed higher detection of severe epithelial dysplasia (to 10.3%), leukoplakia (to 62.1%) and esophagus cancer (to 3.5%) and improvement of the results of endoscopic treatment.

Cytokeratin alteration in oral leukoplakia and oral squamous cell carcinoma

Intermediate filaments are involved in cell migration and intracellular signal transduction pathways. In a variety of organs, the expression of distinct intermediary filaments are further associated with distinct steps of malignant transformation. In this study, we seeked to define the cytokeratin (Ck) expression pattern in oral leukoplakia and oral squamous cell carcinoma (OSCC). One hundred and ninety-two patients with OSCC, 117 patients with oral leukoplakia without dysplasia (OL) and 23 with oral leukoplakia with dysplasia (squamous intraepithelial neoplasia) (OLD) of the oral cavity were investigated for the immunohistochemical expression of Ck 5-6, Ck 8/18, Ck 1 Ck 10, Ck 14, Ck 19 using the tissue microarray technique. Correlations between clinical features and the expression of cytokeratins were evaluated statistically by chi2 tests. The expression of Ck 8/18, Ck 19 and Ck 1 was seen in 3.1% (Ck 8/18), 12.5% (Ck 19), 75.4% (Ck 1) of all leukoplakias, 1.0% (Ck 8/18), 9.4% (Ck 19), 76.8% (Ck 1) in OL, 13.0% (Ck 8/18), 27.3% (Ck 19), 68.4% (Ck 1) in OLD and was significantly associated with the degree of dysplasia (Ck 8/18 p<0.01; Ck 19 p<0.01; Ck 1 p<0.01) and the acquisition of invasive growth properties. The highest frequencies were observed in invasive squamous cell carcinomas. The expression of Ck 8/18 and Ck 19 in transformed oral lesions can be regarded as an early feature in the pathogenesis of invasive OSCC. However, the aberrant expression of Ck 8/18 and Ck 19 in an even higher frequency in invasive carcinomas characterizes the expression of typical glandular cytokeratins as a general progression marker in squamous cell carcinomas. These results can be interpreted as first hints that oral leukoplakias with an expression of Ck 8/18 or 19 independent of dysplasia, should be resected totally since they might indicate an increased progression potential.

[Clinical analysis of the application of Diomed-25 laser in treatment of vocal cord leukoplakia in 30 cases]

OBJECTIVE

To explore the effect of Diomed-25 semi-conductive laser in treatment of vocal cord leukoplakia.

METHOD

From 1997 to 2001, 30 patients with vocal cord leukoplakia were operated in our hospital by Diomed-25 laser, acoustic analysis were compared and studied before and after operation. All the patients were followed up, ranging from 1 to 5 years.

RESULT

There were 16 cases of simple leukoplakia and 14 cases with mild, moderate or severe atypical hyperplasia in this study. None of simple leukoplakia and mild atypical hyperplasia had malignant change, but 2 cases had malignant change who were the cases with moderate and severe atypical hyperplasia respectively. Acoustic analysis showed significant difference between preoperation and postoperation group (P < 0.05).

CONCLUSION

The Diomed-25 laser was proved valuable in treating patients with vocal cord leukoplakia.

Extensive bilateral renal pelvis, ureter and bladder leukoplakia

We are presenting a case of leukoplakia spread to the bilateral renal pelvis, ureter and bladder in a 52-year-old woman. We believe this case is important because it involves leukoplakia that is more extensive than in any cases previously cited in the literature. No other possible etiologic cause except a heavy smoking habit was defined. Conservative follow-up was preferred to aggressive surgery.

Ocular surface squamous neoplasia: report of an unusual case and review of the literature

OBJECTIVE

To describe a case of leukoplakia and underlying intraepithelial squamous cell neoplasia of the palpebral conjunctiva presenting in a patient wearing an ocular prosthesis.

METHODS

The clinical presentation, histopathological findings and surgical outcome are described in a 62-year-old man in whom leukoplakic lesions of the palpebral conjunctiva in a socket fitted with an ocular prosthesis were noted in addition to squamous cell carcinoma of the lower lid skin.

RESULTS

Histopathological examination revealed islands of squamous cell carcinoma in the skin lesion and squamous cell carcinoma-in-situ in the leukoplakic conjunctival specimen. Successful tumour excision and lid reconstruction were performed.

CONCLUSION

This report highlights the successful treatment of long-standing conjunctival squamous cell carcinoma-in-situ associated with an ocular prosthesis and a general tendency to pre-neoplastic lesions of the skin. Regular examination of the sockets of patients wearing long-standing ocular prostheses is recommended.

[Parelectric spectroscopy for noninvasive diagnosis of laryngeal tissue]

Under the influence of an external electrical field, every biological tissue displays characteristic parelectric properties that can be recorded by radiofrequency spectroscopy in a noninvasive contact mode. Parelectric spectroscopy was investigated for its utility as a complementary noninvasive diagnostic procedure in examinations of the larynx, in particular in terms of its ability to differentiate tissue properties. Parelectric spectroscopy was performed in 10 patients submitted to surgical ablation of vocal cord neoplasia under local or insufflation anaesthesia. Measurements were obtained in the area of the neoplasia, and in macroscopically normal tissue in the corresponding vocal cord. In all cases, intra-individual comparison with normal vocal cord tissue revealed lower dipole density and reduced mobility of the affected vocal cord. In addition, the difference between normal and pathological tissue in terms of the parelectric parameters increased with age. The absolute values of dipolar density and mobility revealed no tendency to correlate with different kinds of vocal cord neoplasia. Parelectric spectroscopy may be a useful additional diagnostic tool for monitoring the course of epithelial changes in the larynx.

[Perianal precancerous conditions (Bowen disease, Paget disease, Carcinoma in situ, Buschke-Lowenstein tumor)]

Perianal premalignant lesions are rare. Any suspicious perianal lesion or any perianal exanthema, that does not heal by non-surgical treatment has to be biopsied for histology. Many premalignant lesions are diagnosed as an incidental finding after anorectal surgery: any anorectal specimen must be examined by the pathologist. Leukoplakia is a facultative premalignant condition. High-grade anal intraepithelial neoplasia (AIN) is an in situ squamous cell carcinoma, associated with papillomavirus infection. Bowen's disease and Bowenoid papulosis are clinical variations of high-grade AIN. Buschke-Löwenstein tumour (giant condyloma) is a locally destructive tumour, that does not infiltrate or cause metastases. Paget's disease is a premalignant lesion like AIN, associated with other malignancies.

Regression of laryngeal dysplasia after serial microflap excision

There is no consensus on the ideal management of premalignant lesions of the larynx. Published reports describe the use of mucosal stripping, microsurgical techniques, CO2 laser excision and ablation, and even conservation laryngeal surgery and radiotherapy. We performed a retrospective evaluation of 43 men and 11 women who underwent serial excision of dysplastic lesions with the microflap technique between 1990 and 2001. The average age of the patients was 57.2 years; 64% had a history of cigarette smoking, and 46% a history of alcohol consumption. The lesions were located on the middle part of the left vocal fold in 65% and on the mid-portion of the right vocal fold in 66%. The patients were followed for an average of 4.4 years. Of the 20 patients with severe dysplasia or carcinoma in situ treated with the microflap technique, only 1 progressed to invasive disease. Overall, there was a reduction in the severity of dysplasia after each procedure (p = .0008). The microflap technique reliably reduced the severity of dysplastic lesions of the vocal fold and was effective in local disease control.

[Clinical analysis of vocal cord leukoplakia in 32 cases]

OBJECTIVE

To investigate the types and curative effects of the leukoplakia of the vocal cord.

METHOD

From 1990 to 1996, 32 patients (38 sides) with leukoplakia of vocal cord were operated in our hospital, postoperative follow-up ranged from 2 to 7 years.

RESULT

There were eighteen cases of simple leukoplakia and fourteen cases of leukoplakia with mild, moderate and severe atypical hyperplasia in this study. None of simple leukoplakia had malignant change. But there were 33%, 75% and 75% of cases had malignant change in the leukoplakia with mild, moderate and severe atypical hyperplasia respectively. To surgical methods, there was no significant difference, in the rate of malignant change either by the microlaryngoscopy or thyrotomy.

CONCLUSION

Simple leukoplakia can be cured. More attention should be paid to the leukoplakia with any types of atypical hyperplasia during clinical management. The postoperative results were not depend on the surgical methods.

[The study of the evolution of laryngeal premalignant lesions]

Hyperkeratosis of the laryngeal epithelium is considered a clinically premalignant lesion that develops into invasive carcinoma in about 7-20% of cases. We reviewed 125 cases of patients with laryngeal keratosis in biopsy obtained by direct laryngocopy over a 10-year period. The evolution of these lesions to malignancy was conditioned by age, the presence of atypias in the initial lesions, and smoking; smoking is a modifiable factor. Surgery is the treatment of choice, with periodic follow-up for three to five years. The literature was reviewed.

[YAG:Nd laser cw in treatment of precancerous states of the penis]

In the paper the results are presented of treatment with laser light generated by a YAG:Nd cw laser of a patient with Queyrat disease and another patient with leukoplakia of the glans penis. As the result of the treatment carried out, the lesions revealed during six-month observation regressed completely, leaving no scars. No impairment of sexual functions was found in the treated patients.

Conservative extirpative treatment of cancer of the penis

Carcinoma in situ, erythroplasia of Queyrat, and Bowen's disease have been managed successfully with a variety of conservative techniques. The management of invasive carcinoma remains controversial. The goal of surgical treatment in these patients is complete excision of the tumor with adequate tumor-free margins. While partial or total penile amputation is necessary for complete eradication of some primary penile tumors, many patients can be managed adequately with optimal preservation of function. Young and reliable patients with well-differentiated tumors are the most suitable candidates for conservative surgical extirpation.

[Use of bi-active coagulation in the treatment of various associated and precancerous diseases of the cervix uteri]

An atraumatic technique of bioactive electrocoagulation in an electrolyte solution has been developed for associated or precancerous cervical conditions involving the superficial mucosa. This modality reduced the incidence of postoperative complications and relapses. The procedure is painless and electrically safe.

Progression of leukoplakia of the bladder to squamous cell carcinoma 19 years after complete urinary diversion

We report a rare case of squamous cell carcinoma developing in a defunctionalized bladder with known leukoplakia 19 years after urinary diversion. We conclude from this case that once the initial metaplasia of the transitional epithelium of the urinary tract to leukoplakia has occurred chronic irritation by (infected) urine is not required to cause further progression to squamous cell carcinoma. Therefore, we recommend prophylactic cystectomy if palliative urinary diversion for relief of symptoms is considered in patients with leukoplakia of the bladder.

[Vocal function after laser therapy]

A prospective study of vocal function was undertaken before and after CO2-laser surgery for benign tumors and lesions of the larynx: 50 patients with polyps, Reinke's oedema's, leukoplakia etc. were investigated and controlled phoniatrically, including indirect microlaryngoscopy and microstroboscopy. 3 investigators rated the results independently. Laser surgery can minimise tissue damage, as demonstrated by good restoration of vocal function.

Conservative surgical management of leukoplakia of upper urinary tract

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Our experience in the surgical treatment of cancer and precancerous lesions of the lower lip

We report on 279 patients with cancer and precancerous conditions of the lower lip who have been surgically treated. Cure rates and cosmetic results are evaluated in relation to the different surgical techniques employed. The types of tumors are statistically analyzed and discussed.

Malignant skin conditions

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CO2 laser in malignant lesions of the larynx

The CO2 laser is being used in several otolaryngology departments around the world. Clinical experience has shown that it is a unique surgical tool in the management of benign and in some malignant lesions of the larynx. Until now, little has been written about its indications in patients with carcinomas of the larynx. The purpose of this paper is to present our experience with 58 patients with various premalignant and malignant lesions of the larynx in which the CO2 laser was employed as a curative or palliative debulking procedure.

Squamous cell carcinoma presenting 10 years after cystectomy for leukoplakia

Leukoplakia of the bladder is widely accepted as a precancerous lesion. We describe a patient in whom squamous cell carcinoma presented as an enterourethral fistula 10 years after cystectomy for leukoplakia of the bladder. During cystectomy we left most of the prostate and posterior urethra intact to preserve potency. In view of this case we recommend that in patients with bladder leukoplakia in whom ablative surgery is being contemplated a complete cystoprostatectomy be performed and a urethrectomy be considered seriously.

Cryosurgery in the treatment of lichen sclerosus et atrophicus of the vulva

Twelve patients with lichen sclerosus et atrophicus of the vulva were treated by a nitrous oxide cryoprobe. All had had severe itching which was relieved in the post-operative period in 75% and for 3 years in 50%. Eight had histologically proven leukoplakia which cleared post-operatively in five (62.5%) and remained clear at three years in four (50%). In one patient pruritus, leukoplakia and ultimately squamous carcinoma appeared.