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Pimolbutr K, Lim WT, Leeson R, Hopper C, Kalavrezos N, Liew C, Schilling C, Sinha D, Jay A, Agrawal R, Porter S, Fedele S. Prognosis of oral epithelial dysplasia in individuals with and without oral lichen planus. Oral Dis 2024; 30:504-517. [PMID: 36648368 DOI: 10.1111/odi.14503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate the role of oral lichen planus (OLP) on the long-term prognosis of oral epithelial dysplasia (OED). METHODS Retrospective single-centre cohort study using the 2007-2019 database of the Head and Neck Cancer and Oral Medicine units of University College London Hospital. The exposure of interest was the presence of OLP, and the prognostic outcomes included the development of new primary episodes of OED, progression to malignancy and mortality. Cox proportional hazard and Poisson regression models were performed. RESULTS A total of 299 patients, of whom 144 had OED arising on the background of OLP (OLP/OED) and 155 had OED without underlying OLP (non-OLP/OED), were included. A pre-existing diagnosis of OLP was significantly associated with a twofold increased risk of subsequent primary OED events (HR = 2.02, p = 0.04), which also developed faster (1.46 vs. 2.96 years, p = 0.04) and with more involvement of non-cancer-prone sites (p = 0.001) than in the non-OLP/OED group. There was no difference between groups in the progression to malignancy or mortality. CONCLUSIONS Oral lichen planus/OED patients are at higher risk of multiple episodes of primary OED, which can develop faster and at non-cancer-prone sites as compared to non-OLP/OED individuals. Further research is needed to clarify the effects of OLP upon progression to OSCC and mortality.
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Affiliation(s)
- Kununya Pimolbutr
- UCL Eastman Dental Institute, University College London, London, UK
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Woei Tatt Lim
- Oral and Maxillofacial Surgery Department, Sarawak General Hospital, Kuching, Malaysia
| | - Rachel Leeson
- UCL Eastman Dental Institute, University College London, London, UK
| | - Colin Hopper
- UCL Eastman Dental Institute, University College London, London, UK
| | - Nicholas Kalavrezos
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Colin Liew
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Clare Schilling
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Deepti Sinha
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Amrita Jay
- Department of Cellular Pathology, University College London Hospitals (UCLH), London, UK
| | - Reshma Agrawal
- Department of Cellular Pathology, University College London Hospitals (UCLH), London, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, London, UK
| | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, London, UK
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Obermeier KT, Wuersching SN, Liokatis P, Smolka W, Poxleitner P, Kleye C, Ehrenfeld M, Kollmuss M, Otto S. Metastases of OSCC Based on Oral Lichen Ruber Planus. Cancers (Basel) 2023; 15:4092. [PMID: 37627120 PMCID: PMC10452896 DOI: 10.3390/cancers15164092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/05/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Oral lichen ruber planus (OLP) is a poorly understood chronically inflammatory disease of the oral mucosa. Malignant transformation into oral squamous cell carcinoma (OSCC) is reported in between 1-2% of cases in the literature. After malignant transformation, surgical treatment-meaning tumor resection combined with neck dissection-is recommended. The recommended extent of treatment is controversial in the literature because this kind of OSCC is often a highly differentiated tumor with a lower risk for lymph nodal spreading. This study aims to overview 103 patients treated in our department due to OLP. The primary outcome parameter was the development of metastases in OLP patients compared to a group of OSCC patients without OLP and the comparison of survival in between both groups. Statistical analysis showed a significantly lower risk for patients with OSCC and with OLP for lymph nodal spreading (p = 0.013). Patients with OSCC and without OLP had a 4.76-higher risk for lymph nodal spreading. On the other hand, second metachronous tumor occurred more often in patients with OSCC and OLP. Overall, OSCC based on OLP occurs more often in female patients, is more highly differentiated and comes with a lower risk for metastases but has a higher risk for second metachronous tumors. Therefore, special attention should be paid to patients with OSCC based on OLP when planning adjuvant therapy and clinical follow-up. The indication for postoperative radiation should be made cautiously in this case, and clinical controls should be performed more closely due to the risk of recurrent disease or tumors at different locations.
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Affiliation(s)
- Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Sabina Noreen Wuersching
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig Maximilian University Munich, Goethestrasse 70, 80336 Munich, Germany; (S.N.W.)
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Christin Kleye
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
| | - Maximilian Kollmuss
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig Maximilian University Munich, Goethestrasse 70, 80336 Munich, Germany; (S.N.W.)
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University Munich, 80337 Munich, Germany; (P.L.); (W.S.); (P.P.)
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Best DL, Herzog C, Powell C, Braun T, Ward BB, Moe J. Oral Lichen Planus-Associated Oral Cavity Squamous Cell Carcinoma Is Associated With Improved Survival and Increased Risk of Recurrence. J Oral Maxillofac Surg 2020; 78:1193-1202. [PMID: 32114008 DOI: 10.1016/j.joms.2020.01.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE We investigated the overall survival (OS), disease-specific survival (DSS), and disease-free survival among patients with oral lichen planus-associated oral cavity squamous cell carcinoma (OLP-OCSCC). The secondary objective was to assess the annual risk of tumor recurrence or second primary tumor (SPT). MATERIALS AND METHODS A comparative retrospective study was performed of patients with OLP-OCSCC presenting between June 2007 and December 2018 to the Department of Oral and Maxillofacial Surgery, Michigan Medicine (Ann Arbor, MI) and patients with OCSCC in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database (1973 to 2015). RESULTS A total of 87 patients with OLP-OCSCC met the inclusion criteria, and 55,165 patients with OCSCC from the SEER database were included. The proportion of women was greater in the OLP group than in the SEER group (56.3 vs 38.0%; P < .001). In the OLP group, 47.1% had no smoking history and 43.7% had no alcohol history. Most patients in the OLP group had presented with stage I disease (46.0%) compared with 31.7% in the SEER group (P = .004). Overall, the OS and DSS were significantly greater in the OLP group than in the SEER group at all points from 1 to 5 years (P ≤ .01). In the OLP group, 46 patients (52.9%) had at least 1 recurrence or SPT. At 10 years, the predicted mean number of recurrences was 1.93 per patient (95% confidence interval, 1.56 to 2.39). CONCLUSIONS OLP-OCSCC frequently affects women, nonsmokers, and nondrinkers and presents with localized disease at a high frequency. Patients with OLP-OCSCC have increased OS and DSS and a greater risk of tumor recurrence or SPT compared with OCSCC in the general population. Lifelong, frequent surveillance is recommended for patients with OLP-OCSCC owing to the risk of late recurrence. Future studies are needed to understand the pathophysiology of OLP-OCSCC.
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Affiliation(s)
- David L Best
- Resident, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Curtis Herzog
- Dental Student, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Corey Powell
- Consultant, Department of Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, MI
| | - Thomas Braun
- Professor, Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Brent B Ward
- Section Head, Chair, and Associate Professor, Department of Oral and Maxillofacial Surgery; and Director, Oncology/Microvascular Surgery Fellowship, University of Michigan, Ann Arbor, MI
| | - Justine Moe
- Assistant Professor and Residency Program Director, Department of Oral and Maxillofacial Surgery; and Associate Director, Oncology/Microvascular Surgery Fellowship, University of Michigan, Ann Arbor, MI.
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Peng Q, Zhang J, Ye X, Zhou G. Tumor-like microenvironment in oral lichen planus: evidence of malignant transformation? Expert Rev Clin Immunol 2017; 13:635-643. [PMID: 28494213 DOI: 10.1080/1744666x.2017.1295852] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Qiao Peng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
| | - Jing Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
| | - Xiaojing Ye
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
| | - Gang Zhou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, P.R. China
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Abstract
Background: Oral lichenoid lesions or reactions (OLLs/OLRs) are clinical and histological contemporaries of the classical oral lichen planus (OLP) that have generated a lot of debate in literature. In contrast to the idiopathic nature of OLP, OLLs are often associated with a known identifiable inciting factor. A superficial examination of these lesions clinically and histologically often reveals many similarities with OLP, but recent data indicate that distinguishable features do exist and form the basis of most classifications. Aims and Objectives: This paper attempts to collate available data in English literature on OLLs, highlight distinguishing features clinically and histologically and reflect on the malignant transformation potential and treatment modalities of the condition. Materials and Methods: A comprehensive search of medical and dental databases including PubMed, Ovid, Cochrane, Pubget, Researchgate, and non-medical search engines were utilized for the review. The search words included “oral lichen planus”, “oral lichenoid lesions”, “oral drug reactions”, “lichenoid dysplasia”, and “adverse effects of dental materials”. Review Results: OLLs seem to grossly underrated and most cases were clubbed as OLP. Definite clinical and histological features were uncovered to establish the identity of this lesion. Associations with dental restorative materials, drugs, and medications have been conclusively proven in the etiology of this condition. Specific markers are being utilized to diagnose the condition and monitor its progress. Conclusion: Substantial differentiating features were uncovered to delineate OLLs as a separate entity with definite etiology, pathogenesis, and a high malignant transformation rate compared with OLP.
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Affiliation(s)
- Venkatesh Vishwanath Kamath
- Department of Oral and Maxillofacial Pathology, Dr. Syamala Reddy Dental College, Hospital and Research Centre, Munnekolala, Marathalli, Bangalore, Karnataka, India
| | - Krishnanand Setlur
- Department of Oral and Maxillofacial Pathology, Dr. Syamala Reddy Dental College, Hospital and Research Centre, Munnekolala, Marathalli, Bangalore, Karnataka, India
| | - Komali Yerlagudda
- Department of Oral and Maxillofacial Pathology, Dr. Syamala Reddy Dental College, Hospital and Research Centre, Munnekolala, Marathalli, Bangalore, Karnataka, India
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Bombeccari GP, Guzzi G, Tettamanti M, Giannì AB, Baj A, Pallotti F, Spadari F. Oral lichen planus and malignant transformation: a longitudinal cohort study. ACTA ACUST UNITED AC 2011; 112:328-34. [PMID: 21782485 DOI: 10.1016/j.tripleo.2011.04.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 04/03/2011] [Accepted: 04/13/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Oral lichen planus (OLP) is associated with risk for developing oral squamous cell carcinoma (OSCC). We performed a 7-year prospective study to assess the incidence of malignant transformation of OLP among adults. STUDY DESIGN Three hundred twenty-seven OLP patients, 229 women (70.0%) and 98 men (30.0%), were observed during the follow-up period. RESULTS During a mean follow-up of 81.7 months, 8 of 327 patients developed an OSCC in OLP areas (0.36%/y), yielding the high overall standardized incidence ratio of 17.7 (95% confidence interval [CI] 8.8-35.3). The standardized incidence ratio for OSCC was significantly higher in women [27.0 (95% CI 11.2-64.8)] than in men [11.2 (95% CI 3.6-34.9)]. Six OSCCs were well differentiated (75%) and 2 moderately differentiated (25%). Three subjects (37.5%) developed recurrences within 2 years (mean 16.1 ± 3.5 months). Disease-free survival rate after 69.8 months was 97.3%. CONCLUSIONS OLP was associated with a significant increase in the risk for OSCC. Close surveillance may help to reduce the morbidity of OSCC arising from OLP at 24 months.
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Affiliation(s)
- Gian Paolo Bombeccari
- Unit of Oral Pathology and Medicine, Department of Reconstructive and Diagnostic Surgical Sciences, University of Milan, Milan, Italy.
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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. [PMID: 17112770 DOI: 10.1016/j.oraloncology.2006.09.006] [Citation(s) in RCA: 192] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 09/11/2006] [Indexed: 11/21/2022]
Abstract
Recently, we reported the preliminary results of a prospective study on the possible premalignant character of oral lichen planus (OLP) and oral lichenoid lesions (OLL). Based on these data it was concluded that there was some but no convincing support for the hypothesis that patients with OLL have an increased risk of development of oral cancer, but not so in patients with OLP. In the present treatise the results of prolonged follow-up of this cohort of patients have been described. A study group of 192 patients, 67 patients diagnosed with OLP and 125 patients with OLL, according to revised World Health Organization diagnostic criteria, was followed for periods ranging from 7.6 to 96.9 months (mean, 55.9 months). The expected number of patients with oral cancer in the group of patients with OLP and in the group of patients with OLL was estimated by comparing the number of patients, their ages, sex, and the length of follow-up to annual incidence rates of oral cancer for the general population in The Netherlands. The binomial test was used to determine whether the observed number of cases of cancer in the OLP group and the OLL group exceeded the expected numbers. Four out of 192 patients, two men and two women, developed a squamous cell carcinoma of the oral mucosa during follow-up. All malignant transformations occurred in the OLL group. The malignant transformation of the OLL group, based on a mean follow-up of 53.8 months, was calculated at 0.71% per year. A comparison of the expected against actual figures for the development of carcinomas revealed no increase in patients with OLP and a 142-fold increase in patients with OLL, the latter being statistically significant, with a p-value of 0.044. The present data give support to the hypothesis that patients with OLL have an increased risk of development of oral cancer. There seems to be no increased risk in patients with OLP. In view of our results we advise to monitor only the subgroup of OLL patients twice a year for early detection of possible malignant transformation.
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Affiliation(s)
- E H van der Meij
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
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Cardozo Pereira AL, Castro Jacques CDM, Cabral MG, Cardoso AS, Ramos-e-Silva M. Oral lichen planus part II: therapy and malignant transformation. Skinmed 2004; 3:19-22. [PMID: 14724408 DOI: 10.1111/j.1540-9740.2004.02523.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Oral lichen planus lesions can cause discomfort, pain, and a burning sensation. Therefore, all professionals who deal with the oral cavity must be aware of all the therapeutic options for it. This article presents a review of the literature on oral lichen planus, focusing on its treatment, and also discusses the important and controversial potential for the evolution of oral lichen planus into epidermoid carcinoma.
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Affiliation(s)
- Ana Líbia Cardozo Pereira
- University Hospital and School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Mignogna MD, Lo Russo L, Fedele S, Ruoppo E, Califano L, Lo Muzio L. Clinical behaviour of malignant transforming oral lichen planus. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2002; 28:838-43. [PMID: 12477475 DOI: 10.1053/ejso.2002.1302] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS At present oral lichen planus (OLP) is classified among precancerous conditions but very few data are available in literature regarding prognosis of OLP-related cancers. The aim of this paper is to evaluate clinical long-term behaviour of OLP-related oral squamous cell carcinomas (OSCCs). METHODS Clinical history and data from follow-up regarding 21 patients undergoing malignant transformation of OLP have been critically revised. RESULTS In a mean time of 2.6 years from diagnosis of OLP, patients developed OSCCs. Histopathologically, two carinomas showed a moderate degree of differentiation, while the others were well differentiated. Six (28.5%) were in situ OSCC, in eight (30%) was found a microinvasive pattern of infiltration, one was a stage II tumour and the remaining (6 cases) were stage I tumours. During follow up, four patients (19%) have developed another OSCC in a mean time of 11 months from the first occurrence. In two men (10% of cases), multiple OSCCs occurred and in five cases (24%) lymph nodal metastases were detected. CONCLUSIONS Our study points out an alarming tendency in developing second primary metachronous tumours (33.3%) of the oral cavity and nodal metastases (23.8%), especially if we consider their early stages. Thus we always recommend a strict follow-up of OLP patients with clinical oral and neck examination every 2 months for 6-9 months since OSCC diagnosis is made and, after, three times a year.
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Affiliation(s)
- M D Mignogna
- Department of Oral Medicine and Pathology, University of Naples Federico II, Faculty of Medicine, School of Dentistry, Naples, Italy.
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