|Year : 2017 | Volume
| Issue : 3 | Page : 116-124
|Clinicopathological profile and malignant transformation in oral lichen planus: A retrospective study
Alokenath Bandyopadhyay, Shyam Sundar Behura, Roquaiya Nishat, Kailash Chandra Dash, Lipsa Bhuyan, Sujatha Ramachandra
Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
|Date of Submission||03-Jan-2017|
|Date of Acceptance||27-Mar-2017|
|Date of Web Publication||22-May-2017|
Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: The aim of this study was to analyze the histopathologically diagnosed cases of oral lichen planus (OLP) in terms of age, gender, clinical variant, site, hyperpigmentation, systemic illness, grade of dysplasia, and associated malignant transformation. This study also intended to do a review of reported cases of OLP with malignant transformation.
Materials and Methods: One hundred and forty-three cases of histopathologically diagnosed OLP between 2010 and 2016 were retrospectively reviewed. Demographic and clinicopathological data including malignant transformation were obtained. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) software for Windows version 20.0 (IBM SPSS, SPSS Inc., Chicago, IL, USA). A review of published literature on OLP with malignant transformation was also done from 1988 to 2017 and tabulated.
Results: OLP in this study showed a male predilection with most of the patients in the third decade. The buccal mucosa (bilateral presentation) was the most common site (79.72%), and reticular type was the most common clinical type (79.02%) followed by erosive type (20.98%). The majority (92.31%) of cases were diagnosed with OLP without dysplasia. The rest (7.69%) of dysplastic cases were predominantly seen in the buccal mucosa of 58 years and above, female patients manifesting mainly as erosive type. Two patients (1.4%) previously diagnosed clinically and histopathologically as OLP developed oral squamous cell carcinoma.
Conclusion: The present investigation revealed the predominance of OLP among middle-aged male population and the prevalence of bilateral involvement of buccal mucosa. Two of our cases showed malignant transformation over an average period of 3.5 years. The outcome of this study emphasizes the role of clinical follow-up of patients with OLP.
Keywords: Malignant transformation, oral lichen planus, prevalence
|How to cite this article:|
Bandyopadhyay A, Behura SS, Nishat R, Dash KC, Bhuyan L, Ramachandra S. Clinicopathological profile and malignant transformation in oral lichen planus: A retrospective study. J Int Soc Prevent Communit Dent 2017;7:116-24
|How to cite this URL:|
Bandyopadhyay A, Behura SS, Nishat R, Dash KC, Bhuyan L, Ramachandra S. Clinicopathological profile and malignant transformation in oral lichen planus: A retrospective study. J Int Soc Prevent Communit Dent [serial online] 2017 [cited 2022 Jan 16];7:116-24. Available from: https://www.jispcd.org/text.asp?2017/7/3/116/206664
| Introduction|| |
Oral lichen planus (OLP) is one of the common immune-mediated mucocutaneous disease characterized by chronic inflammatory process. The World Health Organization (WHO) has described OLP as a “potentially malignant disorder.” Patients with OLP should be closely monitored; however, the risk of progression to carcinoma is comparatively lower than other potentially malignant disorders., The disease is usually seen in about 1%–2% of the population, mostly affecting females in the third to sixth decade of life. Various sites in the oral cavity are affected with buccal mucosa being the most common site followed by tongue and gingiva. Clinical variants include reticular, erosive, atrophic, bullous, papular, and plaque-like, with reticular variant being the most common. Histopathologically, OLP is characterized by subepithelial band of lymphohistiocytic infiltrate and basal keratinocyte degeneration.
OLP is considered as a T-cell-mediated autoimmune disease wherein the cytotoxic CD8+ T-cells trigger apoptosis of the basal keratinocytes. Several antigen-specific and nonspecific inflammatory mechanisms have been put forward to explain the pathogenesis of disease; however, the exact mechanism remains unknown.
Several studies have been done in the past, determining the rate of malignant transformation of OLP, since Hallopeau first described a case of carcinoma arising in lichen planus of oral mucosa in the year 1910. The reported transformation rate documented in the past literature varies from 0% to 9% with erosive form being the most commonly associated clinical variant., The period required for malignant transformation varies too. According to a study by Fang et al. on 2119 OLP patients, 1.1% of them developed into squamous cell carcinoma.
The present retrospective study was done to analyze the histopathologically diagnosed cases of OLP in terms of age, gender, clinical variant, site, hyperpigmentation, systemic illness, grade of dysplasia, and associated malignant transformation. The cases diagnosed as OLP from 2010 to 2016 were obtained from the archives of Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, and were analyzed. This study also intended to do a review of reported cases of OLP with malignant transformation.
| Materials and Methods|| |
The study consisted of retrospectively reviewed cases of histopathologically diagnosed OLP according to the modified WHO criteria  [Table 1] from the archived records of the patients in the Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha. [Figure 1] and [Figure 2] show classical histopathological features required to diagnose OLP as per the modified WHO criteria.
|Table 1: World Health Organization diagnostic criteria (1978) for oral lichen planus|
Click here to view
|Figure 1: Photomicrograph showing stratified squamous epithelium with saw-tooth rete pegs and intense lymphocytic infiltrate subepithelially in a band-like pattern (H and E, ×10)|
Click here to view
|Figure 2: Photomicrograph showing basal cell degeneration and subepithelial lymphocytic infiltration (H and E, ×40)|
Click here to view
A total of 143 records were identified between 2010 and 2016, which were confirmed cases of OLP and hence constituted the study sample. The study was approved by the Institutional Ethics Committee (Letter no. KIMS/KIIT/IEC/51/2016). Demographic and clinicopathological data such as gender, age, habits of tobacco and alcohol use, clinical presentation, site of involvement, medical history, clinical types, and presence or absence of dysplasia in histopathology were obtained. Patients with coexisting tobacco-associated potentially malignant disorders were excluded from the study.
The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) software for Windows version 20.0 (IBM SPSS, SPSS Inc., Chicago, IL, USA). Chi-square test was done to establish association between clinicopathological characteristics and occurrence of OLP. The association between malignant transformation of OLP and clinicopathological parameters was descriptively analyzed. P < 0.05 was considered statistically significant.
| Results|| |
A total of 143 histopathologically diagnosed cases of OLP were retrospectively analyzed, of which 78 (54.55%) were male and 65 (45.45%) were female. Most of the patients were in the third decade of life. The buccal mucosa (bilateral presentation) was the most common site of occurrence (79.72%). Only two clinical types were encountered in the entire study population, of which the reticular type was the most common form and was present in 113 (79.02%) patients. The remaining 20.98% cases showed erosive type of OLP. About 68.53% of patients did not show any associated systemic diseases. Of the remaining 31.47% who reported incidence of systemic diseases, Type 2 diabetes mellitus (DM) was the most common (13.29%) followed by concomitant presence of both Type 2 DM and hypertension (8.39%). [Table 2] shows the distribution of patients by different epidemiological and clinical characteristics.
|Table 2: Distribution of patients by different epidemiological and clinical characteristics|
Click here to view
Male and female patients were compared and significant differences were observed in terms of age (P = 0.0140), site (P = 0.0060) of occurrence, associated systemic diseases (P = 0.0030), and presence or absence of pigmentation (P = 0160). Buccal mucosa was the most common site in both males and females. Type 2 DM was the most commonly associated systemic disease in females whereas coexistence of Type 2 DM and hypertension was most common among males. Almost 58.49% of females had intraoral pigmentation mainly in the buccal mucosa in contrast to 41.51% in males. [Table 3] shows comparison of male and female patients in terms of different demographic, clinical, and pathological characteristics.
|Table 3: Comparison of male and female patients in terms of different demographic, clinical, and pathological characteristics|
Click here to view
When the association between the prevalence of OLP (with and without dysplasia) and different demographic and clinical parameters was considered, a significant difference was observed in terms of age groups (P < 0.001), site of the lesion (P < 0.0280), and clinical types (P < 0.0001). The majority (92.31%) of cases in this study were diagnosed with OLP without dysplasia. The rest (7.69%) of cases, which showed dysplasia, were predominantly seen in females in the age group of 58 years and above, commonly occurring in the buccal mucosa and manifesting mainly as erosive type. [Table 4] shows the association between the prevalence of OLP (with and without dysplasia) and different demographic and clinical parameters.
|Table 4: Association between prevalence of oral lichen planus (with and without dysplasia) and different demographic and clinical parameters|
Click here to view
Of 143 patients, two (1.4%) previously diagnosed clinically and histopathologically as OLP developed oral squamous cell carcinoma (OSCC) when the association between prevalence of malignant transformation and various demographic and clinical characteristics was studied. Various characteristics of OLP cases with malignant transformation are given in [Table 5]. Both cases of OSCC occurred in the erosive variety of OLP occurring in the buccal mucosa in female patients with the age of 48 years and above.
|Table 5: Characteristics of oral lichen planus cases with malignant transformation|
Click here to view
| Discussion|| |
The present retrospective study attempted to elucidate the epidemiological and clinicopathological characteristics of 143 patients attending the OPD of Kalinga Institute of Dental Sciences, Bhubaneswar, who were histopathologically diagnosed as OLP. The strength of the present study was that it was one of the very few studies done in India to evaluate the presence of dysplasia in OLP cases and associated malignant transformation. Our findings add on to the very limited data available regarding OLP and rate of malignant transformation in Indian population. In spite of the several limitations of retrospective studies, they are useful in evaluating patient populations.
The clinical features of patients in our study shared several similarities and dissimilarities with other previously reported studies. In our study, we obtained a male predilection (54.55%) which was in accordance with the study done by Munde et al. However, Shen et al., Eisen, Xue et al., Thorn et al., Bermejo-Fenoll et al., Irani et al., Tovaru et al., and Budimir et al. reported a female predilection and hence their results were not in accordance with our study.,,,,,,, Most of our patients were in the third decade of life, which is lower than the mean age reported in Czech Republic (55.2 years), Central China (50.4 years), Spain (56.4 years), Iran (44.5 years), Romania (52 years), UK (52.0 years), and Italy (56.7 years).,,,,,, The probable explanation for this may be the geographic and ethnic differences.
In our study, bilateral presentation of OLP in the buccal mucosa (79.72%) was the most common which was in accordance with the studies done by Munde et al., Shen et al., Radochová et al., Oliveira Alves et al., Irani et al., and Tovaru et al.,,,,, Unilateral occurrence of lichen planus was observed in few of our cases, which clinically mimics another condition known as lichenoid reaction. Although they also show few similarities histopathologically, lichenoid reaction can be differentiated from lichen planus on the basis of subepithelial as well as diffuse infiltration of inflammatory infiltrate with substantial numbers of plasma cells, eosinophils, and neutrophils in contrast to only a subepithelial band of lymphocytes in the latter.
Reticular type (79.02%) was the most common clinical type encountered which was in concordance with the studies done by Munde et al., Shen et al., Radochová et al., Oliveira Alves et al., Tovaru et al., and Budimir et al.,,,,, However, Irani et al. reported erosive form to be the most common type in Iranian population.
About 68.53% of the patients in our study did not show any associated systemic illness. On the other hand, DM was the most common systemic illness encountered followed by concomitant presence of DM and hypertension. This finding may support the literature claim of correlation of OLP with DM.
The associated hyperpigmentation in oral mucosa has been attributed to postinflammatory changes, which results in increased melanin pigmentation and abnormal distribution of melanin and melanophages.,, About 37.06% of patients showed associated hyperpigmentation, with males being more commonly affected and buccal mucosa being the most common site. Patients with Type 2 DM showed greater incidence of hyperpigmentation. Munde et al. reported almost a similar prevalence rate (29.69%) of hyperpigmentation whereas Chitturi et al. reported a higher rate (60%) of associated hyperpigmentation.,
In our study, of 143 patients, 11 (7.69%) showed evidence of dysplasia (seven mild dysplasia; four moderate dysplasia) whereas Munde et al. reported a lower prevalence rate of 3.13% which was consistent with the reports of Murti et al., On a higher end, Irani et al. reported dysplastic changes in 10.71% of their cases. Most of the dysplastic changes were associated with erosive variant in all the studies. Krutchkoff and Eisenberg in the year 1985 proposed the term “lichenoid dysplasia” to characterize cases that on microscopy had both features of OLP and epithelial dysplasia. However, the WHO does not classify “lichenoid dysplasia” as a separate entity.
A malignant transformation rate of 1.4% was reported in our study which was in consonant with the studies of Shen et al., Fang et al., Eisen, Gorsky et al., Markopoulos et al., Rajentheran et al., Chainani-Wu et al., and Kesic et al.,,,,,,, On the other hand, Lo Muzio et al., Lanfranchi-Tizeira et al., and Kaplan et al. reported a higher malignant transformation rate of 4.9%, 6.5%, and 5.8% in Italian, Argentinian, and Israeli population, respectively.,, In the Indian scenario, Munde et al. did not report any malignant transformation in their cases. The only limitation in our study is the smaller sample size. There were no controversies raised by the study. A systematic review was done for studies on OLP and its malignant transformation which is tabulated in [Table 6].
|Table 6: Systematic review of studies done on oral lichen planus and its rate of malignant transformation|
Click here to view
| Conclusion|| |
The prevalence study was first of its kind in Eastern India to elucidate the epidemiological, clinicopathological characteristics, and malignant transformation in patients with OLP. The primary outcome of the study revealed dysplastic changes in 7.69% of our cases and 72.7% of these cases were associated with erosive clinical type. Two of our cases showed malignant transformation over an average period of 3.5 years. Moreover, the secondary outcome constituted the predominance of OLP among middle-aged male population and the prevalence of bilateral involvement of buccal mucosa. Reticular lesions were the most frequent followed by erosive form. More number of studies with larger sample size and long-term follow-up should be taken up to estimate the innate prospective of OLP to turn neoplastic. Multivariate logistic regression analysis of malignant transformation in OLP can be done to determine the independent predictive factors. The outcome of this study emphasizes the role of clinical follow-up of patients with OLP.
Financial Support and Sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gopalakrishnan A, Balan A, Kumar NR, Haris PS, Bindu P. Malignant potential of oral lichen planus an analysis of literature over the past 20 years. Int J Appl Dent Sci 2016;2:1-5.
Fitzpatrick SG, Hirsch SA, Gordon SC. The malignant transformation of oral lichen planus and oral lichenoid lesions: A systematic review. J Am Dent Assoc 2014;145:45-56.
Munde AD, Karle RR, Wankhede PK, Shaikh SS, Kulkurni M. Demographic and clinical profile of oral lichen planus: A retrospective study. Contemp Clin Dent 2013;4:181-5.
] [Full text]
Shen ZY, Liu W, Zhu LK, Feng JQ, Tang GY, Zhou ZT. A retrospective clinicopathological study on oral lichen planus and malignant transformation: Analysis of 518 cases. Med Oral Patol Oral Cir Bucal 2012;17:e943-7.
Radochová V, Drízhal I, Slezák R. A retrospective study of 171 patients with oral lichen planus in the East Bohemia – Czech Republic – Single center experience. J Clin Exp Dent 2014;6:e556-61.
Hallopeau H. Sur un cas de lichen de Wilson gingival avec neoplasie voisine dans la region maxillaire. Bull Soc Fr Dermatol Syphiligr 1910;17:32.
Bornstein MM, Kalas L, Lemp S, Altermatt HJ, Rees TD, Buser D. Oral lichen planus and malignant transformation: A retrospective follow-up study of clinical and histopathologic data. Quintessence Int 2006;37:261-71.
Oliveira Alves MG, Almeida JD, Balducci I, Guimarães Cabral LA. Oral lichen planus: A retrospective study of 110 Brazilian patients. BMC Res Notes 2010;3:157.
Fang M, Zhang W, Chen Y, He Z. Malignant transformation of oral lichen planus: A retrospective study of 23 cases. Quintessence Int 2009;40:235-42.
Shivhare P, Gupta A, Yadav M, Konidena A, Shankarnarayan L. Evaluation of different diagnostic criteria of diseases manifesting the oral cavity – A review. Part-1. J Oral Biol Craniofac Res 2016;6:135-41.
Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: A study of 723 patients. J Am Acad Dermatol 2002;46:207-14.
Xue JL, Fan MW, Wang SZ, Chen XM, Li Y, Wang L. A clinical study of 674 patients with oral lichen planus in China. J Oral Pathol Med 2005;34:467-72.
Thorn JJ, Holmstrup P, Rindum J, Pindborg JJ. Course of various clinical forms of oral lichen planus. A prospective follow-up study of 611 patients. J Oral Pathol 1988;17:213-8.
Bermejo-Fenoll A, Sanchez-Siles M, López-Jornet P, Camacho-Alonso F, Salazar-Sanchez N. Premalignant nature of oral lichen planus. A retrospective study of 550 oral lichen planus patients from South-Eastern Spain. Oral Oncol 2009;45:e54-6.
Irani S, Esfahani AM, Ghorbani A. Dysplastic change rate in cases of oral lichen planus: A retrospective study of 112 cases in an Iranian population. J Oral Maxillofac Pathol 2016;20:395-9.
] [Full text]
Tovaru S, Parlatescu I, Gheorghe C, Tovaru M, Costache M, Sardella A. Oral lichen planus: A retrospective study of 633 patients from Bucharest, Romania. Med Oral Patol Oral Cir Bucal 2013;18:e201-6.
Budimir V, Richter I, Andabak-Rogulj A, Vucicevic-Boras V, Budimir J, Brailo V. Oral lichen planus – Retrospective study of 563 Croatian patients. Med Oral Patol Oral Cir Bucal 2014;19:e255-60.
Ingafou M, Leao JC, Porter SR, Scully C. Oral lichen planus: A retrospective study of 690 British patients. Oral Dis 2006;12:463-8.
Gandolfo S, Richiardi L, Carrozzo M, Broccoletti R, Carbone M, Pagano M, et al.
Risk of oral squamous cell carcinoma in 402 patients with oral lichen planus: A follow-up study in an Italian population. Oral Oncol 2004;40:77-83.
Bajpai M, Agarwal D, Bhalla A, VatchalaRani RM, Kumar M. Unilateral lichen planus: A rare case report. J Nat Sci Biol Med 2014;5:453-5.
Rajendran R. Diseases of the skin. In: Rajendran R, Sivapathasundaram B, editors. Shafer's Textbook of Oral Pathology. 5th
ed. New Delhi: Elsevier; 2006. p. 1099-162.
Gondak RO, da Silva-Jorge R, Jorge J, Lopes MA, Vargas PA. Oral pigmented lesions: Clinicopathologic features and review of the literature. Med Oral Patol Oral Cir Bucal 2012;17:e919-24.
Morelli JG, Norris DA. Influence of inflammatory mediators and cytokines on human melanocyte function. J Invest Dermatol 1993;100 2 Suppl:191S-5S.
Sreeja C, Ramakrishnan K, Vijayalakshmi D, Devi M, Aesha I, Vijayabanu B. Oral pigmentation: A review. J Pharm Bioallied Sci 2015;7 Suppl 2:S403-8.
Chitturi RT, Sindhuja P, Parameswar RA, Nirmal RM, Reddy BV, Dineshshankar J, et al.
A clinical study on oral lichen planus with special emphasis on hyperpigmentation. J Pharm Bioallied Sci 2015;7 Suppl 2:S495-8.
Murti PR, Daftary DK, Bhonsle RB, Gupta PC, Mehta FS, Pindborg JJ. Malignant potential of oral lichen planus: Observations in 722 patients from India. J Oral Pathol 1986;15:71-7.
Patil S, Rao RS, Sanketh DS, Warnakulasuriya S. Lichenoid dysplasia revisited – Evidence from a review of Indian archives. J Oral Pathol Med 2015;44:507-14.
Gorsky M, Raviv M, Moskona D, Laufer M, Bodner L. Clinical characteristics and treatment of patients with oral lichen planus in Israel. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:644-9.
Markopoulos AK, Antoniades D, Papanayotou P, Trigonidis G. Malignant potential of oral lichen planus; a follow-up study of 326 patients. Oral Oncol 1997;33:263-9.
Rajentheran R, McLean NR, Kelly CG, Reed MF, Nolan A. Malignant transformation of oral lichen planus. Eur J Surg Oncol 1999;25:520-3.
Chainani-Wu N, Silverman S Jr., Lozada-Nur F, Mayer P, Watson JJ. Oral lichen planus: Patient profile, disease progression and treatment responses. J Am Dent Assoc 2001;132:901-9.
Kesic L, Obradovic R, Mihailovic D, Radicevic G, Stankovic S, Todorovic K. Incidence and treatment outcome of oral lichen planus in Southeast Serbia in a 10-year period (1997-2007). Vojnosanit Pregl 2009;66:435-9.
Lo Muzio L, Mignogna MD, Favia G, Procaccini M, Testa NF, Bucci E. The possible association between oral lichen planus and oral squamous cell carcinoma: A clinical evaluation on 14 cases and a review of the literature. Oral Oncol 1998;34:239-46.
Lanfranchi-Tizeira HE, Aguas SC, Sano SM. Malignant transformation of atypical oral lichen planus: A review of 32 cases. Med Oral 2003;8:2-9.
Kaplan I, Ventura-Sharabi Y, Gal G, Calderon S, Anavi Y. The dynamics of oral lichen planus: A retrospective clinicopathological study. Head Neck Pathol 2012;6:178-83.
Gümrü B. A retrospective study of 370 patients with oral lichen planus in Turkey. Med Oral Patol Oral Cir Bucal 2013;18:e427-32.
Bardellini E, Amadori F, Flocchini P, Bonadeo S, Majorana A. Clinicopathological features and malignant transformation of oral lichen planus: A 12-years retrospective study. Acta Odontol Scand 2013;71:834-40.
Bombeccari GP, Guzzi G, Tettamanti M, Giannì AB, Baj A, Pallotti F, et al.
Oral lichen planus and malignant transformation: A longitudinal cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:328-34.
Torrente-Castells E, Figueiredo R, Berini-Aytés L, Gay-Escoda C. Clinical features of oral lichen planus. A retrospective study of 65 cases. Med Oral Patol Oral Cir Bucal 2010;15:e685-90.
Thongprasom K, Youngnak-Piboonratanakit P, Pongsiriwet S, Laothumthut T, Kanjanabud P, Rutchakitprakarn L. A multicenter study of oral lichen planus in Thai patients. J Investig Clin Dent 2010;1:29-36.
Pakfetrat A, Javadzadeh-Bolouri A, Basir-Shabestari S, Falaki F. Oral lichen planus: A retrospective study of 420 Iranian patients. Med Oral Patol Oral Cir Bucal 2009;14:E315-8.
Carbone M, Arduino PG, Carrozzo M, Gandolfo S, Argiolas MR, Bertolusso G, et al.
Course of oral lichen planus: A retrospective study of 808 Northern Italian patients. Oral Dis 2009;15:235-43.
Thongprasom K, Mravak-Stipetic M, Luckprom P, Canjuga I, Biocina-Lukenda D, Vidovic-Juras D, et al.
Oral lichen planus: A retrospective comparative study between Thai and Croatian patients. Acta Dermatovenerol Croat 2009;17:2-8.
Zhang JH, Zhou ZT. Oral lichen planus: A retrospective study of 724 Chinese patients. Zhonghua Kou Qiang Yi Xue Za Zhi 2007;42:669-71.
van der Meij EH, Mast H, van der Waal I. The possible premalignant character of oral lichen planus and oral lichenoid lesions: A prospective five-year follow-up study of 192 patients. Oral Oncol 2007;43:742-8.
Hsue SS, Wang WC, Chen CH, Lin CC, Chen YK, Lin LM. Malignant transformation in 1458 patients with potentially malignant oral mucosal disorders: A follow-up study based in a Taiwanese hospital. J Oral Pathol Med 2007;36:25-9.
Laeijendecker R, van Joost T, Kuizinga MC, Tank B, Neumann HA. Premalignant nature of oral lichen planus. Acta Derm Venereol 2005;85:516-20.
Al-Bayati S. Oral lichen planus: A clinical study of 123 patients attending an oral medicine clinic, Baghdad University, Iraq. Gulf Med J 2012;1:10-4.
Rödström PO, Jontell M, Mattsson U, Holmberg E. Cancer and oral lichen planus in a Swedish population. Oral Oncol 2004;40:131-8.
van der Meij EH, Schepman KP, van der Waal I. The possible premalignant character of oral lichen planus and oral lichenoid lesions: A prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:164-71.
Mignogna MD, Lo Muzio L, Lo Russo L, Fedele S, Ruoppo E, Bucci E. Clinical guidelines in early detection of oral squamous cell carcinoma arising in oral lichen planus: A 5-year experience. Oral Oncol 2001;37:262-7.
Silverman S Jr., Bahl S. Oral lichen planus update: Clinical characteristics, treatment responses, and malignant transformation. Am J Dent 1997;10:259-63.
Rode M, Kansky AA, Kogoj-Rode M. Reticular form of oral lichen planus. A 19-year observation period in 75 patients from Slovenia. Acta Dermatovenerol Alp Pannonica Adriat 2000;9:137-41.
Moncarz V, Ulmansky M, Lustmann J. Lichen planus: Exploring its malignant potential. J Am Dent Assoc 1993;124:102-8.
Barnard NA, Scully C, Eveson JW, Cunningham S, Porter SR. Oral cancer development in patients with oral lichen planus. J Oral Pathol Med 1993;22:421-4.
Voûte AB, de Jong WF, Schulten EA, Snow GB, van der Waal I. Possible premalignant character of oral lichen planus. The Amsterdam experience. J Oral Pathol Med 1992;21:326-9.
Sigurgeirsson B, Lindelöf B. Lichen planus and malignancy. An epidemiologic study of 2071 patients and a review of the literature. Arch Dermatol 1991;127:1684-8.
Silverman S Jr., Gorsky M, Lozada-Nur F, Giannotti K. A prospective study of findings and management in 214 patients with oral lichen planus. Oral Surg Oral Med Oral Pathol 1991;72:665-70.
Salem G. Oral lichen planus among 4277 patients from Gizan, Saudi Arabia. Community Dent Oral Epidemiol 1989;17:322-4.
Holmstrup P, Thorn JJ, Rindum J, Pindborg JJ. Malignant development of lichen planus-affected oral mucosa. J Oral Pathol 1988;17:219-25.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
| Article Access Statistics|
| Viewed||1965 |
| Printed||45 |
| Emailed||0 |
| PDF Downloaded||209 |
| Comments ||[Add] |