Beyond Clinicopathological Criteria: A Practical Management Framework for Oral Lichen Planus

Area of Science:

• Oral Medicine
• Dermatology
• Oncology

Background:

• Oral lichen planus (OLP) is a chronic inflammatory condition with potential for malignant transformation.
• Diagnostic challenges arise from overlapping clinical and histopathological features with other oral white lesions.
• Current diagnostic standards are evolving, emphasizing clinicopathological correlation.

Purpose of the Study:

• To synthesize current diagnostic criteria for OLP.
• To characterize key differential diagnoses of OLP.
• To establish an evidence-based diagnostic framework for clinicians.

Main Methods:

• A comprehensive literature search was performed across major databases (PubMed/MEDLINE, Scopus, Web of Science, Embase).
• Eligible studies underwent systematic screening and narrative summarization.
• A clinical case illustration was used to demonstrate the diagnostic approach.

Main Results:

• Twenty-nine studies were summarized, highlighting the AAOMP 2016 criteria.
• Key differentials include frictional keratosis, chronic hyperplastic candidiasis, and lichenoid reactions.
• Malignant transformation rates are ~1.43%, rising to 5.13% with dysplasia, necessitating surveillance.

Conclusions:

• Accurate OLP diagnosis relies on integrating clinical presentation with histopathological findings.
• A systematic diagnostic algorithm is crucial for differentiating OLP from mimics.
• Long-term monitoring is essential for managing the risk of malignant transformation.