A Rare Case of Malignant Transformation of Oral Lichen Planus of the Mandible

Abstract

Summary:Oral lichen planus (OLP) is an immune-mediated mucocutaneous disease associated with an increased risk in oral squamous cell carcinoma (OSCC). Nearly all cases of malignant transformation have been reported in patients >40 years old. We report the case of a 37-year-old woman with a 5-year history of erosive OLP who presented with malignant transformation to OSCC. Delineating the margins of the disease was impossible at presentation given her OLP, and she was initially treated with concurrent chemoradiation therapy. She then developed a recurrence of the mandibular alveolar ridge. The patient was successfully treated with a composite resection including a segmental mandibulectomy, buccal mucosa resection, partial glossectomy, and ipsilateral neck dissection. This was reconstructed with a free fibula osteo-septo-cutaneous flap. Mandibular OSCC is a rare complication of OLP with few reports on effective reconstructive interventions. The case represents the youngest reported patient with mandibular OSCC arising in the context of OLP and highlights the utility of the free vascularized fibula graft in the treatment of these patients.

Successful treatment of erosive lichen planus with Upadacitinib complicated by oral squamous cell carcinoma

“…8 Based on a review of the literature, there is evidence to support the malignant potential of oral LP. 9 One particular review found that those with erosive or atrophic oral LP are more likely to undergo malignant transformation than any other subtype of LP. 10 While another found that those with LP lesions on the tongue had 1.82 times the risk of developing oral SCC.…”

Oral Lichen Planus – Related Connection with HLA-System Antigens

“…The questions that remained unanswered are to which degree OLP is independent from the OSCCs and whether the carcinoma has developed from the OLP or is it just a coincidence. [27] The malignant transformation was described for the first time in the distant 1965. [28] The epidemiological data suggests that the malignant transformation of OLP is not equally represented in all the regions of the oral cavity.…”

“…[30] The most common malignant transformation of OLP is OSCCs, with extremely uncertain prognosis and life threatening condition. [27] The pathogenesis of OLP is very complex and includes a possible antigen presentation from the oral keratinocytes the origin of which can be exogenous or endogenous. [31][32][33] This antigen activator is accompanied by a mixed inflammatory response that is consisted mainly of T-cells, macrophage, mast cells as well as cytotoxins and cytotoxic molecules.…”