Malignant transformation of oral lichen planus: a retrospective study of 565 Japanese patients

Abstract

Background Oral lichen planus (OLP) is a chronic inflammatory oral mucosa disease that is recognized as an oral potentially malignant disorder. However, the potentially malignant nature of OLP remains unclear. Methods We designed this study to examine the demographic and clinical characteristics of patients with OLP and evaluate the associated malignant transformation rate. A total of 565 patients with a clinical and histopathological diagnosis of OLP who presented at our department between 2001 and 2017 were retrospectively studied. Patients who had clinical and histopathological features of oral lichenoid lesions (OLLs) classified as oral lichenoid contact lesions, oral lichenoid drug reactions and oral lichenoid lesions of graft-versus-host disease were excluded. Results The study population included 123 men and 442 women aged 21–93 years (mean ± standard deviation, 60.5 ± 11.8). The 565 patients were followed up for a duration of 55.9 ± 45.3 months, during which 4 (0.7%) patients developed squamous cell carcinoma (SCC). In three of these 4 patients who developed SCC, the clinical type of OLP was the red type. Conclusions Our results suggested that OLP was associated with a low risk of malignant transformation. We recommend regular follow-up for OLP patients and clear differentiation of oral epithelial dysplasia and OLLs to enable early detection of malignant transformation. Further investigation of the clinical risk factors associated with malignant transformation is necessary.

Significance of immunohistochemistry biomarkers in prediction of malignant transformation of oral lichen planus: A systematic review

“…Of interest, Lee et al , observed a significantly higher level of PCNA expression in atrophic OLP lesions compared to hypertrophic lesions. This, in turn, correlates with the clinical observations that higher rates of MT were found in patients with atrophic OLP lesions ( 44 ). Overexpression of PCNA has also been reported to be associated with neoplastic progression in oral submucosa fibrosis, which is classified by WHO as an oral potentially malignant disorder ( 6 ).…”

Therapeutic strategies for oral lichen planus: State of the art and new insights

“…A regular screening for oral cancer in OLP is recommended. Indeed, several risk factors for malignant transformations in OLP have been reported, including erosive clinical phenotype, involvement of the tongue, female gender, and advanced age ( 7 , 8 ). At this regard, Fitzpatrick et al found that 85 (1.09%) of 7806 OLP patients and 4 (3.2%) of 125 patients with oral lichenoid lesions developed an oral squamous cell carcinoma ( 9 ).…”

“…In addition, a recent systematic review detected a transformation rate of 1.37 for OLP ( 11 ). Therefore, an annual monitoring to detect early malignant lesions is strongly recommended and it should be performed by oral medicine specialists ( 7 , 8 ).…”

Risk of Malignant Transformation in 3173 Subjects with Histopathologically Confirmed Oral Lichen Planus: A 33-Year Cohort Study in Northern Italy

“…In the last 3 decades, many authors have tried to analyze the factors related to the possible modalities of cancerization. However, even though OLP malignant transformation is probably the most important disease complication, to date, there is still little knowledge about the clinical behavior and prognosis of these cancers [13][14][15][16][17].…”