Office-based laser treatment of oral premalignant lesions

White and red lesions of the oral cavity remain a diagnostic and treatment challenge. Leukoplakia and erythroplakia are the most common premalignant lesions of the oral cavity (oral premalignant lesions [OPLs]). They have a potential for mucosal growth and malignant transformation. Obtaining a representative biopsy of the lesion is imperative to confirm histologic diagnosis and exclude malignant invasion. Subsequent management of such lesions includes observation, excision, ablation, or topical medical therapies. Despite these treatments, the lesions have a tendency to recur and prolonged observation with multiple retreatments is the rule rather than the exception. Laser treatment is well described for management of premalignant lesions. With the advent of smaller and more cost-effective lasers, this technology is now feasible for outpatient management of such lesions in the office setting. Furthermore, angiolytic lasers can be used to target the vasculature of oral lesions, leaving intact mucosa, which should result in less discomfort for the patient. We describe our management approach to premalignant oral cavity lesions as well as more benign oral cavity lesions amenable to treatment via an office-based laser. We also detail our experience and the theory behind various types of ablative and angiolytic lasers including CO2, thulium, 532-nm and 940-nm diode, and 532-nm pulsed potassium-titanyl phosphate laser in this setting.