Neoplastic transformation of oral lichen: case report and review of the literature

Abstract

Aim of the present investigation was to analyse the possible malignant transformation of oral lichen planus to carcinoma, especially in the atrophic erosive forms and those displaying plaques involving the top of the tongue. A review has been made of the literature, from 1986 to the present day. This search outlines the relationship between oral lichen planus, hepatitis C virus infection, Epstein-Barr virus infection and the importance of periodic follow-up in all patients with oral lichen planus. The case is described of malignant transformation of oral lichen planus to oral cancer in a female presenting asymptomatic hepatitis C virus infection. The clinical history confirms the most important aspects of the relationship between oral lichen planus and oral cancer. Oral lichen planus should be considered as a precancerous lesion, particularly in patients presenting hepatitis C virus infection, requiring follow-up, at close intervals, starting from 3 months after diagnosis.

Fig. 1

Inflammation of lichen planus type. Lymphocyte infiltration occupies connective stroma even covering basal layer of epithelium (arrow) (Biopsy 06464-I-01, H&E, 40X).

Fig. 2

Ulcerated area. No evidence of important cytological abnormalities (Biopsy 00467-I-03, H&E,100X).

Fig. 3

Lichenoid dysplasia. Epithelial thecae display structural disorders and cytological abnormalities e.g. increased nucleo-plasmic ratio anisokaryosis, nuclear hyperchromatism, irregular nuclear margin (Biopsy 01484-I-02, H&E, 250X).

Fig. 4

Squamous cell carcinoma. Area showing marked degree of differentiation (Biopsy 03166-I-02, H&E, 100X).