Premalignant nature of oral and vulval lichen planus: Facts and controversies
Introduction
Lichen planus (LP) is an inflammatory dermatosis of still unknown etiology. LP is currently considered to be a probable autoimmune process, triggered by antigenic alterations on the cell surface of the basal layer of the epithelium.1, 2 The cutaneous lesions present clinically as polygonal, shiny, isolated, and symmetrical papules of erythematous-violet coloration with whitish streaks on the surface (Wickham striae). Although LP can affect any part of the tegument, it presents a preference for the flexural surfaces of the forearms, thighs, third distal of legs, abdomen, and sacral area. It can also involve fingernails and mucous membranes.3, 4
Mucous membrane lesions in LP were first described in 1869 by Erasmus Wilson,5 who presented 50 patients with LP, including 3 with lesions in the mouth. The most frequently affected mucous membrane is the mouth, although lesions have been described in the mucosa of the genitalia, nose, pharynx, larynx, esophagus, stomach, intestines, anus, conjunctiva, urethra, and bladder.6
Several publications have correlated mucous membrane lesions with the development of epidermoid carcinoma, mainly the oral lesions,7 and with lesser frequency, the vulval lesions.7, 8 Some rare cases of malignant transformation of cutaneous lesions have also been described, without indicating an increased risk in the healthy population.9 Those occurrences are more related to a predisposing factor than to an intrinsic potential of malignant evolution. Prolonged use of arsenic, previous irradiation of the lesion site and presence of hypertrophic or chronic verrucous lesions of lower limbs were possibly involved in the eventual malignancy reported in those patients.10, 11, 12
The World Health Organization (WHO) defines a premalignant condition as “a generalized state associated with a significantly increased risk of cancer,” and includes the oral lesions of LP in that classification.13 Still a major topic of discussion, however, is whether LP of the mucous membranes should be characterized as an intrinsically premalignant condition or merely as a facilitator of the action of carcinogenic agents, such as tabagism (the condition created by excessive tobacco use), alcoholism, nutritional errors, poor hygiene, immunosuppressive states, family history, hepatitis C, and viruses with oncogenic potential, such as herpesvirus types I and II, Epstein-Barr, and the human papillomavirus.14, 15
Section snippets
Oral lichen planus
Oral lichen planus (OLP) can involve any area of the oral cavity but is found more frequently in the buccal mucosa.16 Its general prevalence ranges from 1% to 2% of the population and from 50% to 77% in patients with LP.4, 17 OLP usually affects individuals aged between 40 and 70 years and is rarely observed in children.18 The oral lesions can precede or accompany the cutaneous lesions and occur as isolated manifestation of the disease in 20% to 30% of patients.1, 2
OLP presents great clinical
Vulval LP
Genital LP lesions can be observed in both sexes, and the shortage of publications about this location of the disease indicates that it is probably less common than the cutaneous and oral lesions. The exact prevalence of vulval lichen planus (VLP) lesions is not known; however, a study published in 1998 showed VLP lesions in 51% of 37 patients LP patients.8 The sample in that study was small, but its result may be an indication that VLP is more prevalent than thought. Many cases are probably
Conclusions
Despite being quite rare, the possibility of the emergence of an epidermoid carcinoma exists at the site of the lesions of the disease, mainly in the lesions of the mucous membranes. The attempt to attribute to OLP or VLP the capacity to self-develop malignancy, independently of the action of possible associated risk factors, should still generate a lot of discussion. Although research groups linked to the WHO have been emphatic about placing OLP as a premalignant condition, a consensus does
References (41)
- et al.
Leukoplakia, lichen planus and other oral keratosis in 23,616 white Americans over the age of 35 years
Oral Surg Oral Med Oral Pathol
(1986) Oral lichen planus: a review
Br J Oral Maxillofac Surg
(2000)- et al.
Lichen planus
J Am Acad Dermatol
(1991) - et al.
Malignant potential of oral lichen planus, a follow-up study of 326 patients
Oral Oncol
(1997) - et al.
Follow-up studies in oral lichen planus
J Oral Surg
(1973) - et al.
Malignant transformation of oral lichen planus
Eur J Surg Oncol
(1999) - et al.
Lichenoid dysplasia: a distinct histopathologic entity
Oral Surg Oral Med Oral Pathol
(1985) Oral lichen planus: a benign lesion
J Oral Maxillofac Surg
(2000)- et al.
Epithelial dysplasia in oral lichen planus. A preliminary report of a Dutch-Hungarian study of 100 cases
Int J Oral Surg
(1984) - et al.
Current controversies in oral lichen planus: Report of an international consensus meeting. Part 2. Clinical management and malignant transformation
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2005)
Malignancies after marrow transplantation for aplastic anemia and fanconi anemia: a joint Seattle and Paris analysis of results in 700 patients
Blood
Oral precancerous and malignant lesions associated with graft-versus-host disease: report of 2 cases
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Amalgam-associated oral lichenoid reactions. Clinical and histologic changes after removal of amalgam fillings
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Vulval lichen planus: progression of pseudoepitheliomatous hyperplasia to invasive vulval carcinomas
BJOG
Oral lichen planus part I: epidemiology, clinics, etiology, immunopathogeny and diagnosis
Skinmed
Lichen planus and associated conditions: investigation and treatment routine
Dermatol Klin
Lichen planus: Review and update on pathogenesis
J Oral Pathol
Oral lichen planus part II: therapy and malignant transformation
Skinmed
Vulval involvement in lichen planus: a study of 37 women
Br J Dermatol
Lichen planus and malignancy. An epidemiologic study of 2071 patients and a review of the literature
Arch Dermatol
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