The progression of proliferative verrucous leukoplakia can be detected through elevated levels of salivary matrix metalloproteinases

The management of follow-up in proliferative verrucous leukoplakia (PVL) cases remains highly challenging due to the absence of established etiological factors and limited understanding of disease progression. The aim of this study was to identify optimal biomarkers of PVL behavior to facilitate decision-making in complex therapeutic management. Salivary levels of matrix metalloproteinases (MMPs) were evaluated in 54 confirmed PVL cases. All patients underwent follow-up at Oral Medicine Department, Dentistry Clinic at University Hospital Pilsen. Unstimulated saliva samples were collected and analyzed for MMP-1, -2, -3, -7, and − 9 concentrations. Criteria for PVL stability and progression were defined. Disease progression in individual cases was retrospectively correlated with salivary MMP levels to identify optimal prognostic markers. Assessment of PVL progression and stability was performed 6 months after salivary MMP sampling. Progression was observed in 63% of patients (34/54). Significant associations between elevated salivary MMP levels and PVL progression were confirmed for four of the five MMPs tested. MMP-1, -3, -7, and − 9 emerged as promising markers. A combination of MMP-3 and MMP-7 demonstrated the best prognostic performance, with a sensitivity of approximately 79.5% and a specificity of 89%. This is the first study to evaluate salivary MMPs for PVL monitoring. Our findings confirm an association between elevated salivary MMP levels and an increased risk of PVL progression. This non-invasive approach may improve clinical management and follow-up of patients with PVL.