Photodynamic Therapy Using Aminolevulinic Acid in Treating Patients With Oral Leukoplakia

Criteria:

* Histologically confirmed oral leukoplakia with dysplasia OR oral leukoplakia with hyperplasia in a high-risk area (e.g., floor of mouth, tongue, or oropharynx)
* Multiple oral leukoplakia lesions are allowed however no more than 5 distinct lesions are biopsied and treated
* All lesions to be treated must be technically accessible by laser
* Patients with oral leukoplakia with hyperplasia in a non-high-risk location (e.g., buccal mucosa from ill-fitting dentures) are not allowed
* Must be willing to undergo baseline biopsies of leukoplakia lesion(s) and surrounding normal tissue 4-8 weeks before therapy and repeat biopsies at 3 months
* No evidence of ongoing radiation damage to the target site
* Karnofsky performance status (PS) 70-100% or Zubrod PS 0-1
* Life expectancy \> 2 years
* Hemoglobin \> 12 g/dL
* Platelet count \> 100,000/mm\^3
* ANC \> 1,500/mm\^3
* Creatinine =\< 1.5 mg/dL
* SGPT and SGOT =\< 1.5 x upper limit of normal (ULN)
* Total bilirubin =\< 1.5 x ULN (a higher level of bilirubin due to a familial metabolism will be considered on an individual basis)
* Willing to adhere to avoidance of sunlight and indoor light exposure for 24 hours after treatment
* Not pregnant or nursing
* No history of allergic reactions attributed to compounds of similar chemical or biological composition to aminolevulinic acid
* No porphyria
* No uncontrolled intercurrent illness including, but not limited to, any of the following:

  * Ongoing or active infection
  * Symptomatic congestive heart failure
  * Unstable angina pectoris
  * Cardiac arrhythmia
  * Psychiatric illness or social situation that, in the opinion of the investigators, would limit compliance or jeopardize the patient or integrity of the data
* Prior treatment for leukoplakia allowed
* No prior photodynamic therapy
* More than 3 months since prior participation in a clinical trial for leukoplakia
* More than 4 weeks since prior ablative therapy to the target lesion
* More than 4 weeks since prior and no concurrent psoralen or PUVA therapy
* No concurrent oral retinoids (e.g., isotretinoin)
* No concurrent use of tanning beds
* No other concurrent investigational agents
* Fertile patients must use effective contraception
* Patients with a previous diagnosis of stage I or II head and neck cancer are eligible provided definitive therapy, including radiation therapy, is completed and the patient has been rendered disease free for \>= 2 years
* No chronic liver disease including those with normal liver function tests