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Laryngeal Leukoplakia Diagnoses Rely on Narrowing Etiologies

Leuko Lot: A Lot of Laryngeal Leukoplakia

Tuesday, September 15, 2020, 3:00 – 4:00 pm (ET)

Laryngology / Broncho-Esophagology Track

 

Priya Krishna, MD, MS

Despite being a common cause of hoarseness, the differential diagnosis for laryngeal leukoplakia is fast. Priya D. Krishna, MD, MS, member of the AAO-HNS Voice Committee, is setting out to provide a framework to guide diagnosis and treatment in her session she moderates on Tuesday.

“It can be difficult to distinguish between infectious and neoplastic etiologies where laryngeal leukoplakia is concerned,” said Dr. Krishna.

“There are fungal etiologies such as blastomycosis, histoplasmosis, coccidiomycosis, and bacterial etiologies like tuberculosis that are not uncommonly confused with squamous cell carcinoma,” she said.

And thus, confusion ensues.

“Biopsy is the only way to truly differentiate these etiologies,” said Dr. Krishna. “However, one can categorize these into etiologies responsive to conservative treatment and etiologies that are recalcitrant to conservative treatment.”

“Clinicians have to be very deliberate in their history taking to help narrow down etiologies. It’s no surprise to otolaryngologists that smoking history is key, and this includes the use of marijuana. Travel history is also important, as we’ve seen a resurgence of tuberculosis in the last several years. Medications are a third element of the history that needs to be carefully examined, especially the use of particular steroid inhalers.”

Sometimes a repeat biopsy is necessary.

“Repeat biopsy is important in any patient who is not responding to a course of conservative treatment, such as discontinuation of a medication or a smoking habit, or completion of a course of antifungal medication,” said Dr. Krishna. “The length of this treatment is variable but at minimum should be three to four weeks. Repeat biopsy is also important if there is discordance with the biopsy result and the clinician’s suspicion of a malignancy based on the clinical features and behavior of the leukoplakia.”

If you miss this live event, it will be available in the on-demand library of education content within 72 hours following the presentation.

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