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figure 10) is described as an advancing form of leukoplakia that starts as a flat, hyperkeratotic white patch and progresses to a verrucous or papillary form and then finally to invasive squamous cell carcinoma.12 PVL has a gender predilection, with a female to male ratio of approximately 4:1, a mean age of 66 years, and a site preference for the buccal mucosa, palate, tongue, and gingivae.12 Conventional risk factors are unknown