Long-Term Care of OLP Patients: A Retrospective Study From a Single Hospital Outpatient Clinic

Oral lichen planus (OLP) is a chronic immune-mediated disorder with malignant potential. However, its real-world clinical course remains incompletely characterized. This study aimed to describe the natural clinical-histopathological trajectory of OLP in a single tertiary centre and to identify factors associated with dysplasia and malignant transformation over time.

We conducted a single-centre retrospective cohort study including patients diagnosed with OLP and followed between 2007 and 2024 at the Oral Medicine Unit of Fondazione Policlinico Universitario A. Gemelli IRCCS. Demographic, clinical (red vs. white phenotype and lesion distribution), microbiological (Candida spp.), therapeutic, and histopathological variables were collected across follow-up. Univariate and multivariable logistic regression models were used to evaluate factors associated with dysplasia and malignant transformation.

Among 308 screened patients, 246 met inclusion criteria (173 women, 70.3%; mean age 63.2 ± 15.0 years) with a mean follow-up of 55.5 ± 37.0 months. At baseline, Candida spp. colonization was detected in 55 patients (22.4%) and was more frequent in red-type OLP than white-type lesions (33.3% vs. 17.0%; OR 2.44, 95% CI 1.32-4.53; p = 0.005). During follow-up, 33 patients (13.4%) developed fungal infection despite an initially negative swab. Epithelial dysplasia emerged in 42 patients (17.1%). In multivariable analysis, dysplasia was independently associated with increasing age (OR 1.06, 95% CI 1.03-1.10; p = 0.0001) and red-type OLP(OR 2.24, 95% CI 1.10-4.55; p = 0.026). Eight patients (3.25%) developed infiltrative OSCC after a mean interval of 28.3 months from OLP diagnosis (range 4-55).

In this long-term single-centre cohort, OLP frequently evolved through dysplasia during follow-up, and malignant transformation occurred in a minority of patients. Older age and red-type phenotype characterized patients more likely to develop dysplasia, while malignant transformation was more frequent in the case of previously documented dysplastic lesions, in keeping with the notion of dysplasia as a step along the carcinogenic pathway, older age, and diffuse lesions.