Introduction and objective:
Proliferative verrucous leukoplakia (PVL) is recognized as a distinct oral potentially malignant disorder (OPMD). It is characterized by progressive, persistent, multifocal oral leukoplakia that changes in clinical appearance and histopathological features over time, and has a marked propensity for malignant transformation. PVL occurs predominantly in older adults, shows a female predominance, and has a weaker association with tobacco and alcohol exposure than conventional oral leukoplakia.

Review methods:
This narrative review was based on a focused literature search in PubMed and Scopus for English‑language articles published up to March 2025, using combinations of the terms ‘proliferative verrucous leukoplakia’, ‘PVL’, ‘oral leukoplakia’, ‘oral potentially malignant disorder’, ‘oral squamous cell carcinoma’, ‘saliva’, ‘salivary biomarkers’, ‘cytokines’, ‘proteomics’, ‘microbiome’, and ‘microRNA’.

Brief description of the state of knowledge:
Most current knowledge comes from small PVL series combined with larger bodies of work on oral leukoplakia and established OSCC, which consistently show that inflammatory cytokines, proteomic changes, dysbiotic microbiome profiles, and deregulated microRNA networks are detectable in saliva.

Summary:
PVL represents a high‑risk, multi‑focal OPMD in which current surveillance strategies rely on repeated biopsies that are invasive and may not reflect the full biological dynamics of the lesion field. Emerging data suggest that salivary biomarkers spanning inflammatory cytokines, multi‑analyte protein panels, microbiome signatures, and microRNA profiles can capture aspects of PVL biology and its progression towards OSCC, but PVL‑specific evidence is still limited and often extrapolated from leukoplakia or cancer cohorts.