New trends in the etiology, diagnosis, and management of laryngeal dysplasia

Laryngeal dysplasia is a premalignant condition of the larynx, and approximately 20 to 40% of patients with moderate to severe dysplasia develop invasive cancer. Tobacco and alcohol use have been implicated as etiologic factors in the development of laryngeal dysplasia, and recent studies suggest that laryngopharyngeal reflux disease (LPRD) may contribute to its formation. In addition, it has recently been shown that dysplastic lesions originate from outgrowths of genetically altered cells, which then undergo progressive genetic alterations and show phenotypic evidence of malignancy. One difficulty in diagnosing laryngeal dysplasia is discriminating between normal and dysplastic tissue. The most common method for assessing dysplasia is microlaryngoscopic examination. However, recent methods, including fluorescent and autofluorescent imaging, may ultimately assist in the assessment of premalignant and malignant laryngeal lesions. Surgical excision by vocal cord stripping or laser ablation is the traditional treatment for laryngeal dysplasia. However, this modality is associated with a disturbingly high rate of recurrence. Because surgical therapy is often inadequate in the management of laryngeal premalignancy, a number of investigators have evaluated the role of chemo-preventive approaches for managing dysplastic laryngeal lesions. A recent report by our group has shown that a combination of 13-cis-retinoic acid, interferon-α, and α-tocopherol can be effective in reversing the clinical and pathologic manifestations of premalignant lesions. Unfortunately, it is unclear whether these agents can reverse the genetic abnormalities underlying the development of laryngeal premalignancy. Thus, chemopreventive agents, which are more effective and less toxic, are currently in development and will be required in the future.