Lichen planus in the oesophagus: are we missing something?

Area of Science:

• Gastroenterology
• Oncology
• Dermatology

Background:

• Oesophageal lichen planus (OLP) is a rare condition, primarily affecting middle-aged to elderly women.
• It carries a potential risk of malignant transformation into squamous cell carcinoma (SCC).
• SCC remains a significant cause of oesophageal cancer globally.

Discussion:

• Increased awareness of OLP is crucial, especially in patients with co-existing cutaneous, oral, or vulval lichen planus.
• Endoscopic investigation, particularly in symptomatic patients, and surveillance of diagnosed OLP cases are recommended.
• Subtle endoscopic features and histological interpretation challenges contribute to underreporting and difficulty in determining true prevalence.

Key Insights:

• OLP is a potentially premalignant condition for oesophageal SCC, necessitating surveillance for early tumour detection and improved cure rates.
• Despite rarity and frequent asymptomatic presentation, OLP can be subtle and easily missed during endoscopic assessment.
• The risk of malignant transformation is not precisely known but may be comparable to oral lichen planus (1-3%).

Outlook:

• Further evaluation of advanced endoscopic techniques, such as magnification indigo carmine chromoendoscopy, may improve OLP detection.
• Enhanced awareness and identification of more cases will improve understanding of OLP's natural history and malignant potential.
• Surveillance strategies could lead to earlier detection of oesophageal SCC arising from OLP, potentially improving patient prognosis.