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Dysplasia in oral lichen planus: relevance, controversies and challenges. A position paper

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Date

2021-07-01

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González-Moles, Miguel Ángel
Warnakulasuriya, Saman
González-Ruiz, Isabel
Ayén, Ángela
González-Ruiz, Lucía
Ruiz-Ávila, Isabel
Ramos-García, Pablo

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Medicina Oral SL
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Abstract

Background Patients with oral lichen planus (OLP) have an increased risk of oral cancer. For this reason, OLP is classified as an oral potentially malignant disorder. However, the precise personal (or individual) risk is unknown. Recent meta-analytical studies have reported that dysplastic OLP may transform to cancer in around 6% of cases, while the rate of transformation is lower (<1.5%) in non-dysplastic cases. The presence of epithelial dysplasia has emerged as the most powerful indicator for assessing cancer risk in oral potentially malignant disorders in routine practice. However, the general acceptance of epithelial dysplasia as an accompanying histologic feature in OLP is subject to great controversy. Many pathologists consider the presence of dysplasia as a criterion to exclude OLP when routinely reporting on this disease. This practice, widespread among oral pathology professionals, has resulted in the underestimation of the potential for malignancy of OLP. Material and Methods A review of the literature was carried out in order to critically analyze the relevance, controversies and challenges encountered across the diagnosis of epithelial dysplasia in OLP. Results 12 studies have been published examining dysplastic changes in OLP, reporting Figures ranging from 0.54% to 25% of cases with dysplasia in the first diagnostic biopsy. The diagnosis of dysplasia in the OLP poses an additional difficulty due to the fact that the affected oral epithelium per se develops changes related to autoimmune aggression. Among the most frequent histological features of OLP that develops dysplasia are basal cell hyperplasia with basaloid appearance, loss of basal cells polarity, cellular and nuclear pleomorphism and irregular stratification. Conclusions Epithelial dysplasia should not be considered an exclusion criterion for OLP; its evaluation requires experienced pathologists in this field.

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MeSH Terms

Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Clinical Laboratory Techniques::Cytological Techniques::Cytodiagnosis::Biopsy
Medical Subject Headings::Diseases::Neoplasms::Neoplastic Processes::Carcinogenesis::Cell Transformation, Neoplastic
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hyperplasia
Medical Subject Headings::Diseases::Stomatognathic Diseases::Mouth Diseases::Lichen Planus, Oral
Medical Subject Headings::Diseases::Stomatognathic Diseases::Mouth Diseases
Medical Subject Headings::Diseases::Stomatognathic Diseases::Mouth Diseases::Mouth Neoplasms
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Dentistry::Pathology, Oral
Medical Subject Headings::Anatomy::Tissues::Epithelium
Medical Subject Headings::Psychiatry and Psychology::Behavior and Behavior Mechanisms::Behavior::Behavioral Symptoms::Aggression

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Oral lichen planus, Epithelial dysplasia, Oral cancer, Hyperplasia, Biopsy, Epithelium, Liquen plano oral, Amaurosis congénita de Leber, Neoplasias de la boca, Hiperplasia, Biopsia, Epitelio

Citation

González-Moles MÁ, Warnakulasuriya S, González-Ruiz I, Ayén Á, González-Ruiz L, Ruiz-Ávila I, et al. Dysplasia in oral lichen planus: relevance, controversies and challenges. A position paper. Med Oral Patol Oral Cir Bucal. 2021 Jul 1;26(4):e541-e548