UNTRODDEN PATHOLOGY; EXPLORING THE UNKNOWN

Does oral lichen Planus truly have a malignant potential?

 A question that has been the source of innumerable  long and inconclusive discussions was one of the questions addressed at the panel discussion " Untrodden Pathology: Exploring the Unknown" organized by Dr Rajiv Desai & Dr RV Subramaniam on 27^th October during the XXI National Conference. Although as expected a consensus on the answer could not be reached, a very interesting fact emerged.

•    The majority of the members of the Indian Association of Oral & Maxillofacial Pathologists present did not believe that Oral Lichen Planus (OLP) has a true malignant potential.

As one of the panelists, I agreed with the majority based on: (following personal opinions on the topic)

•  Highly variable rate of malignant transformation : reported  from 0.03% to 10%·         

• Not seen in dermal forms: A literature search on increased occurrence of dermal carcinomas in skin affected by Lichen Planus does not show any recorded cases.·         

• Changes seen in OLP are a reflection of the progression from inflammation to repair or healing.

•   Dysplastic changes in the absence of contributory habits are very rare.·       

•   Epidemiological studies have been difficult.  There is an expected and  natural interest in the malignant potential of OLP  in countries where either one or both the conditions (OLP & Oral Squamous cell carcinoma) are common. Thus, the possibility of coincidental occurrence of both conditions in the screened /examined population cannot be ruled out.

•  Confounded by similarity with Lichenoid lesions. Chronic inflammation is being increasingly recognized as a contributory factor in malignant transformation of cells thus making lichenoid lesions a more likely candidate for malignant transformation than OLP.