Management of premalignant lesions of the larynx

Abstract

Premalignant lesions of the laryngeal epithelium most commonly involve the glottis. Abnormal appearing mucosal lesions may warrant biopsy for histologic review before an assessment can be made regarding their risk for malignant transformation. Although higher degrees of dysplasia portend a greater chance for malignant transformation, findings of dysplasia or carcinoma in situ should prompt ablative therapy followed by surveillance for recurrence or progression. Risk factor modification remains important not only as a primary prevention strategy, but also to reduce the risk of progression to invasive carcinoma. We review the current evidence pertaining to the work-up and management of premalignant epithelial lesions of the larynx. Surgical excision continues to be the treatment of choice. Alternative therapies like photodynamic therapy and radiation may be employed in selected patients when surgical therapy is not the best option.

Keywords::

• carcinoma in situ
• dysplasia
• laryngeal intraepithelial neoplasm
• larynx
• management
• premalignant

Acknowledgement

The authors would like to thank William M Lydiatt MD, for critical review and conceptual guidance on the subject.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Effective management of laryngeal premalignant lesions affords an opportunity to halt the progression to invasive squamous cell carcinoma.

• • Lack of consensus in pathologic classification systems can lead to difficulty in the interpretation and comparative analysis of available data.

• • Clinical examination may be challenging in differentiating lesions at risk for malignant degeneration and visualized mucosal abnormalities may require directed biopsies and histologic correlation before labeling them as premalignant epithelial lesions.

• • The risk of progression to invasive carcinoma correlates with the degree of dysplasia.

• • Mild and moderate dysplastic lesions have a lower risk of progression to invasive disease when compared with severe dysplasia and carcinoma in situ.

• • Directed biopsies are the current standard of care when diagnosing laryngeal premalignant lesions.

• • Surgical excision of premalignant lesions is the treatment of choice.

• • Radiation therapy may be indicated for patients with contraindications to surgery or with lesions that are difficult to access.

• • Effective management requires a high index of suspicion, prudent use of surgical therapy and histologic analyses, long-term surveillance that includes visualization of the larynx and emphasis on risk factor modification.