# APBA Kısa Özet
This systematic review synthesizes the clinicopathologic features and treatment outcomes of marginal gingival (ring around the collar) leukoplakia, offering a comparative perspective against other oral leukoplakias. Data from a total of 66 patients reveal a distinct risk profile characterized by high recurrence (45.4%) and malignant transformation (24.2%) rates. Histopathologically, hyperkeratosis emerges as the most frequent feature (48.1%), while scalpel excision continues to be the preferred treatment method (74.2%).
# Çalışma neyi araştırdı?
The research aimed to delineate the clinical and pathologic features that distinguish marginal gingival leukoplakia (ring around the collar) from other oral leukoplakias, along with its treatment modalities and long-term outcomes. Specifically, the review investigated the frequency of recurrence, malignant transformation, and histopathologic findings to discern critical factors in the management of this lesion.
# Yöntem
Conducted in accordance with PRISMA guidelines, this study is a systematic review. Major databases and gray literature were searched, resulting in the identification of 17 eligible studies. The methodological quality (risk of bias) of each included study was assessed using the appropriate JBI (Joanna Briggs Institute) checklist. A total of 66 patients (39 women and 27 men; mean age 60 years) were included in the analysis. Data were collected regarding demographic characteristics, lesion type, histopathology, administered treatment modalities, and clinical outcomes (recurrence, malignant transformation).
# Temel bulgular
- Demographics: Among the 66 patients, the female-to-male ratio was 39:27, with a mean age of 60 years.
- Lesion characteristics: Homogeneous lesions constituted 30.3% of cases; 66.7% of lesions involved adjacent teeth. Proliferative verrucous leukoplakia was diagnosed in 33.3% of patients.
- Histopathology: The most frequently observed feature was hyperkeratosis (48.1%); other details were not extensively reported.
- Treatment modalities: Scalpel excision was performed in 74.2% of cases, while laser excision was employed in 15.1%.
- Clinical outcomes: Recurrence was reported in 45.4% of cases, and malignant transformation in 24.2%.
# Bulgular ne anlama geliyor?
The observation that marginal gingival leukoplakia exhibits higher rates of recurrence and malignant transformation compared to other oral leukoplakias suggests that this lesion may exhibit a biologically more aggressive behavior. The prevalence of hyperkeratosis points to a fundamental pathological mechanism of epithelial proliferation. Regarding treatment, the continued predominance of scalpel excision, despite the availability of alternatives, suggests limited current evidence regarding the efficacy of newer modalities; the lower utilization of laser therapy may reflect a gap in available data rather than a lack of potential benefit.
# Klinik önem
These findings advocate for more frequent and long-term monitoring of patients diagnosed with marginal gingival leukoplakia. The high recurrence and malignant transformation risk may necessitate increased frequency of clinical and radiographic follow-up visits. Furthermore, the reporting of histopathologic features such as hyperkeratosis can aid in risk stratification and treatment selection. While scalpel excision remains the prevailing surgical technique, the review advocates for the exploration of individualized approaches and multimodal treatment options to improve clinical outcomes.
# Sınırlılıklar
The most significant limitation of this review is the variable methodological quality of the included studies and the unclear risk-of-bias assessment. The total patient sample size of only 66 imposes constraints on statistical power and generalizability. Additionally, the absence of individual patient-level long-term follow-up data and detailed treatment outcomes hinders the precise determination of recurrence and malignant transformation rates. Future research necessitates larger, prospective cohorts and standardized reporting protocols.