What are possible complications in oral lichen planus (OLP)?

Updated: Sep 15, 2020
  • Author: Jaisri R Thoppay, DDS, MBA, MS; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Oral lichen planus (OLP) and its treatment may predispose people to oral C albicans superinfection.

Patients with oral lichen planus may have a slightly increased risk of oral cancer, which they may be able to reduce (see Prevention).

Oral squamous cell carcinoma (SCC) in patients with oral lichen planus is a feared complication and a controversial issue. In retrospective studies, less than 5% of patients with oral lichen planus who were not using tobacco products developed oral SCC. [42, 43, 44] A 2019 study suggests oral lichen planus and oral SCC share multiple epigenetic alterations and hypothesizes that oral lichen planus is a precursor lesion of oral SCC. [45] Atrophic, erosive, and plaque lesions may be at greater risk of malignant change, although SCC may arise in the unaffected oral mucosa as well. The most important risk factors of oral SCC remain the concomitant use of alcohol and tobacco products. Any additive effect of oral lichen planus is difficult to detect in patients who use both. [46] While controversial, human papillomavirus (HPV) has been suggested to possibly play a role in malignant transformation. [47, 48]

When oral lichen planus is asymptomatic, malignant transformation may be unpredictable as patients often seek treatment when the lesions are symptomatic. The base and lateral tongue are often reported as more susceptible areas. Hence, patient education and recommending a daily self-examination combined with a periodic examination by a specialist is often beneficial for early detection of malignant transformation. One proposed reason for the increased risk of oral SCC in patients with oral lichen planus is that compared with healthy mucosa, the oral mucosa affected by oral lichen planus may be more sensitive to C albicans and to the exogenous mutagens found in tobacco, alcohol, and betel quid. Another is that in patients with oral lichen planus, the chronic inflammatory response and the simultaneous healing response of epithelial wounds may increase the likelihood of cancer-forming gene mutations.

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