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Management of advanced premalignant laryngeal lesions

Johnson, Felicia L.

Current Opinion in Otolaryngology & Head & Neck Surgery: December 2003 - Volume 11 - Issue 6 - pp 462-466
Laryngology and bronchoesophagology

Purpose of review: Laryngeal carcinogenesis is a multistep process with premalignant lesions progressing to invasive carcinoma over a period of years. The approach to these advanced premalignant lesions has always been early diagnosis and treatment to prevent further progression. Unfortunately, with the current means of diagnosis and a lack of consensus regarding treatment of these lesions, the incidence of advanced laryngeal malignancies continues to rise. The purpose of this article is to review the most recent contributions to the literature regarding diagnosis and management of advanced laryngeal premalignant lesions.

Recent findings: The current literature focuses on several new diagnostic procedures to improve early detection of high-risk laryngeal lesions. These procedures include autofluorescence endoscopy, compact endoscopy, and topical 5-aminolevulinic acid. One large long-term study suggests an aggressive surgical approach in the treatment of advanced laryngeal premalignancies to decrease the incidence of malignant transformation. The preliminary results of chemoprevention trials as well as potential new biomarkers are discussed.

Summary: There are several new promising procedures that may have an impact on the early diagnosis of laryngeal precursor lesions. In addition, we are gaining knowledge about the molecular events occurring along the continuum of laryngeal carcinogenesis. This will hopefully allow the identification of additional biomarkers and future targets for chemoprevention.

Department of Otolaryngology, Head and Neck Surgery, Voice and Swallowing Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Correspondence to Felicia L. Johnson, MD, 4301 W. Markham, Slot 543, Little Rock, AR 72205, USA

Tel: 501-686-5011; fax: 501-526-7153; e-mail: fljohnson@uams.edu

© 2003 Lippincott Williams & Wilkins, Inc.