The risk of malignant transformation (oral squamous cell carcinoma) in oral lichen planus and lichenoid lesions
Näytönastekatsaukset
26.5.2026
Level of evidence: B
Oral lichen planus (OLP) is probably associated with malignant transformation in a small proportion (0.2 -1.4%) of OLP patients. Oral lichenoid lesions are probably associated with malignant transformation in 1.38-3.8% of patients.
The evidence is mainly based on observational studies not including controls. However, the incidence of malignant transformation is clearly increased compared to incidence of oral squamous cell carcinoma from national surveys (Finland). Malignant transformation of OLP is associated with tobacco and alcohol consumption, HCV-infection and red (atrophic, ulcerative, bullous) subtype of OLP «Li JW, Li KY, Chan BWA, ym. Rate of Malignant Transformation Differs Based on Diagnostic Criteria for Oral Lichenoid Conditions: A Systematic Review and Meta-Analysis of 24,277 Patients. Cancers (Base»1, «González-Moles MÁ, Ramos-García P. An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024;16»2, «Idrees M, Kujan O, Shearston K, ym. Oral lichen planus has a very low malignant transformation rate: A systematic review and meta-analysis using strict diagnostic and inclusion criteria. J Oral Pathol»3, which are important to note for patient education.
| Reference | Study type | Population | Exposure | Outcomes | Risk of bias «Additional comments for included studies»2 |
|---|---|---|---|---|---|
| «Li JW, Li KY, Chan BWA, ym. Rate of Malignant Transformation Differs Based on Diagnostic Criteria for Oral Lichenoid Conditions: A Systematic Review and Meta-Analysis of 24,277 Patients. Cancers (Base»1 | SR and MA | Patients with Oral lichenoid condition (OLP, OLL, LMD). 54 studies, n=24277 | Oral lichenoid condition (OLP, OLL, LMD) | Primary outcome: the development of OSCC | NOS score ranged between 3 and 8 (28 studies scored ≥6 and 16 studies scored 5, while only one study scored 3). Only 7/54 studies fulfill the adequate follow-up duration (2 years or more). Publication bias cannot be ruled out. |
| «González-Moles MÁ, Ramos-García P. An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024;16»2 | SR and MA | Patients with OLP, OLL, LR, OLP with dysplasia. 101 studies, n=38083 | OLP, OLL, LR, OLP with dysplasia | Primary outcome: the development of OSCC | 11 studies were classified as having high methodological quality (QUIPS score ≥14/18) Not possible to dismiss the presence of publication bias. |
| «Idrees M, Kujan O, Shearston K, ym. Oral lichen planus has a very low malignant transformation rate: A systematic review and meta-analysis using strict diagnostic and inclusion criteria. J Oral Pathol»3 | SR and MA | Patients with OLP. 33 studies, n=12838 | OLP | Primary outcome: the development of OSCC | NOS score ranged between 2 (n=2) and 7 (n=4) |
| «Laniosz V, Torgerson RR, Ramos-Rodriguez AJ, ym. Incidence of squamous cell carcinoma in oral lichen planus: a 25-year population-based study. Int J Dermatol 2019;58(3):296-301 »4 | Retrospective case control study | Patients with OLP, n=303; age and gender matched controls, n=606 | OLP | Development of OSCC | Low |
| «Iocca O, Sollecito TP, Alawi F, ym. Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype. Head Neck »5 | SR and MA | Patients with OPMD (LE, LP, OLL, OSF, PVL, dysplasia). 92 studies OLP 46 studies, n=14 362 OLL 5 studies, n=449 | OLP, OLL | Development of OSCC | NOS, results not presented |
SR=Systematic review; MA=meta-analysis; OLP=oral lichen planus; OLL=oral lichenoid lesion; LMD=lichenoid mucositis with dysplasia; LR=lichenoid reaction; OSCC=oral squamous cell carcinoma; NOS=The Newcastle-Ottawa scale, QUIPS=Quality in Prognosis Studies tool; OPMD=oral potentially malignant disorder
| Reference | Comments |
|---|---|
| «Li JW, Li KY, Chan BWA, ym. Rate of Malignant Transformation Differs Based on Diagnostic Criteria for Oral Lichenoid Conditions: A Systematic Review and Meta-Analysis of 24,277 Patients. Cancers (Base»1 | Inclusion criteria: (1) Full-length, peer-reviewed original research papers published in English from January 2003 to September 2022; (2) Observational studies providing sufficient information on the diagnosis and rate of MT of OLCs. The rate of malignant transformation (MT) in OLP patients diagnosed according to different diagnostic criteria (the 2003 modified WHO criteria and non-2003 modified WHO criteria). Screening, identification and reporting followed the PRISMA framework and analysis the MOOSE guidelines. Data on MT were calculated as a pooled proportion (PP); subgroup analyses and possible risk factors for MT were pooled as odds ratios (ORs). The quality of evidence was evaluated using the GRADE system. |
| «González-Moles MÁ, Ramos-García P. An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024;16»2 | Updates the information (until Nov. 2023) published in the authors' previous meta-analysis (until November 2018). Inclusion criteria: (1) Primary-level studies published in English on the potential for malignancy of OLP; (2) longitudinal study design; (3) if findings arise from overlapping populations of patients with OLP, priority was given to the latest reported results or those offering more comprehensive data for inclusion. The methodological quality and risk of bias of studies was evaluated using the QUIPS tool. The study complies with PRISMA statement and the MOOSE guidelines. |
| «Idrees M, Kujan O, Shearston K, ym. Oral lichen planus has a very low malignant transformation rate: A systematic review and meta-analysis using strict diagnostic and inclusion criteria. J Oral Pathol»3 | Eligibility criteria: observational studies published in the English language from 2003 to January 2020 were included. The criteria for accepting OLP malignant transformation included 1) OLP diagnosed according to the 2003 modifed WHO criteria and 2016 AAOMP criteria, 2) oral carcinoma must have developed at the same location as previously diagnosed OLP and the reported malignancies must have had follow-up of at least 6 mo before transformation to exclude concomitant presentation and 3) the patient's demographics and medical history details should be clearly documented, the patient must not be using any systemic immunosuppressive medication for at least 2 y at the time of cancer diagnosis and the patient had no history of previous head and neck malignancy, organ transplantation or chronic graft-versus-host disease. Was performed in accordance with PRISMA statement. NOS was modified to be combatible with the review's aims. |
| «Laniosz V, Torgerson RR, Ramos-Rodriguez AJ, ym. Incidence of squamous cell carcinoma in oral lichen planus: a 25-year population-based study. Int J Dermatol 2019;58(3):296-301 »4 | Patients who received their first occurrence of International Classification of Disease, Ninth Edition, code 697.0 or Hospital Adaptation of the International Classification of Diseases code 06970110 from January 1, 1986, through December 31, 2010, while a resident of Olmsted County, Minnesota, USA. On the basis of the review of their medical records, patients were classified as incident OLP cases if they met the following criteria: 1) the location was within the oral cavity (from lips to start of the oropharynx); 2) documented presence of the clinical or histopathologic, or both, characteristics met the modified World Health Organization criteria; and 3) no prior history of OSCC was found. Patients with a prior history of oral lichenoid lesions other than OLP by histopathology or clinical examination were excluded from the study. The study did not match controls for potentially confounding factors, including tobacco and alcohol use. |
| «Iocca O, Sollecito TP, Alawi F, ym. Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype. Head Neck »5 | Given the observational nature of the included studies, the authors adopted a statistical conservative approach; for this reason, a 99% confidence interval was chosen for calculations. Prespecified inclusion and exclusion criteria were used but not presented. The analysis was performed synthetizing cumulative MTR of different OPMDs excluding the dysplastic ones. A separate analysis was performed on the risk of MT of mild vs. moderate/severe dysplasia. Included studies with dysplasia and studies with no follow-up reported. Sensitivity analyses were made excl. studies with no follow-up reported. |
MT: malignant transformation; OLC=oral lichenoid condition; OLP=oral lichen planus; WHO=World Health Organization; AAOMP=American Association of Oral and Maxillofacial Pathology; NOS= The Newcastle-Ottawa scale; OSCC=oral squamous cell carcinoma; MTR=malignant transformation rate; OPMD=oral potentially malignant disorder
Results
| Reference | Number of studies and number of patients | Follow-up time | Prevalence E | Absolute risk C | MT rate (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: moderate The quality of evidence is upgraded due to the effect size and the consistency of the study results. | |||||
| «Li JW, Li KY, Chan BWA, ym. Rate of Malignant Transformation Differs Based on Diagnostic Criteria for Oral Lichenoid Conditions: A Systematic Review and Meta-Analysis of 24,277 Patients. Cancers (Base»1 | 54 studies n=24277; 51 studies, n=22578 with OLP; 6 studies, n=717 with OLL; 4 studies, n=153 with LMD; 1 study, n=829, without differentiating OLP and OLL | mean 16.8-272.4 months | 331/24277 (283/22578 OLP; 14/717 OLL; 11/153 LMD) | PP for OLCs: 1.07 % [95% CI = 0.82–1.32]; OLP: 0.94% [95% CI = 0.70–1.19]; OLL: 1.95% [95% CI = 0.15–3.75]; LMD: 6.31% [95% CI = 2.30–10.32] | |
| «González-Moles MÁ, Ramos-García P. An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024;16»2 | 97 studies, n=36889 with OLP; 8 studies, n=856 with OLL; 4 studies, n=164 with LR; 5 studies, n=174 with OLP with dysplasia | 0.24-660 months | 606/38083 | PP for OLP: 1.43% (95% CI = 1.09–1.80); OLL: 1.38% (95% CI = 0.16–3.38); LR: 1.20% (95% CI = 0.00–4.25); OLP with dysplasia: 5.13% (95% CI = 1.90–9.43) | |
| «Idrees M, Kujan O, Shearston K, ym. Oral lichen planus has a very low malignant transformation rate: A systematic review and meta-analysis using strict diagnostic and inclusion criteria. J Oral Pathol»3 | 33 studies, n= 12838 | 1-10 years | 56/12838 | PP 0.2% [95% CI: 0.1%-0.3%] | |
| «Laniosz V, Torgerson RR, Ramos-Rodriguez AJ, ym. Incidence of squamous cell carcinoma in oral lichen planus: a 25-year population-based study. Int J Dermatol 2019;58(3):296-301 »4 | 1 study, n=909 (303 OLP, 606 controls) | 5-20 years | cumulative incidence of OSCC among the OLP cohort was 1.7%, 2.2%, 3.1%, and 3.1% at 5, 10, 15, and 20 years, respectively | cumulative incidence of OSCC among the referent group was 0%, 0.2%, 0.2%, and 0.9% at 5, 10, 15, and 20 years, respectively | HR 4.80, [1.24–18.6]; P = 0.02) |
| «Iocca O, Sollecito TP, Alawi F, ym. Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype. Head Neck »5 | 46 studies, n=14362 with OLP; 5 studies, n= 449 with OLL | Ei eritelty OLP, OLL (laskettavissa taulukosta) | OLP 190/14362 OLL 18/449 | LP 1.4% (99% CI 0.9%-1.9%); OLL 3.8% (99% CI 1.6%-7.00%) | |
E=exposure; CI=confidence interval; MT=malignant transformation; PP=pooled proportion; OSCC=oral squamous cell carcinoma; OLC=oral lichenoid condition; OLP= oral lichen planus; OLL=oral lichenoid lesion; LMD=lichenoid mucositis with dysplasia; LR=lichenoid reaction; HR=hazard ratio; OLP=oral lichen planus
References
- Li JW, Li KY, Chan BWA, ym. Rate of Malignant Transformation Differs Based on Diagnostic Criteria for Oral Lichenoid Conditions: A Systematic Review and Meta-Analysis of 24,277 Patients. Cancers (Basel) 2023;15(9):2537 «PMID: 37174004»PubMed
- González-Moles MÁ, Ramos-García P. An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024;16(3):608 «PMID: 38339358»PubMed
- Idrees M, Kujan O, Shearston K, ym. Oral lichen planus has a very low malignant transformation rate: A systematic review and meta-analysis using strict diagnostic and inclusion criteria. J Oral Pathol Med 2021;50(3):287-298 «PMID: 31981238»PubMed
- Laniosz V, Torgerson RR, Ramos-Rodriguez AJ, ym. Incidence of squamous cell carcinoma in oral lichen planus: a 25-year population-based study. Int J Dermatol 2019;58(3):296-301 «PMID: 30216435»PubMed
- Iocca O, Sollecito TP, Alawi F, ym. Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype. Head Neck 2020;42(3):539-555 «PMID: 31803979»PubMed