Lichenoid morphology could be an early feature of oral proliferative verrucous leukoplakia

Recognition and differentiation of early forms of proliferative verrucous leukoplakia (PVL) could be a challenge to both clinicians and pathologists.

To report on a retrospective study that was carried out on 51 cases of PVL that were initially diagnosed as frictional keratosis, oral leukoplakia or oral lichen planus. A secondary objective is to report on the outcome of malignant transformation during follow-up.

Records of patients seen at an oral medicine clinic with the final clinical diagnosis of PVL were audited for early clinical and histopathologic features in their biopsy at first presentation, and for subsequent malignant transformation.

Fifty-one patients (25 men and 26 women) with a mean age 51 years (men) and 53 years (women) at initial presentation were studied. 28% men and 11.5% women were current smokers. Initial clinical diagnoses were frictional keratoses (n = 4), Leukoplakia (n = 17) and lichen planus (n = 30). Epithelial dysplasia was reported in the initial biopsy in 12 cases and lichen planus/lichenoid features in 22 cases (22/51; 43%). Malignant transformation occurred in 11/51 patients (21.5%).

Lichen planus or lichenoid lesions could be the initial presentation of many PVL cases that later develop multiple leukoplakic lesions with a final diagnosis of PVL.