Lichen planus and malignancy. An epidemiologic study of 2071 patients and a review of the literature

The literature contains 36 reports of squamous cell cancer associated with lichen planus, and several reports on increased frequency of oral cancer in patients with oral lichen planus. To examine the risk of malignant transformation, 2071 patients with lichen planus were followed up for an average of 9.9 years. Only eight squamous cell carcinomas were observed in this population after the first visit for lichen planus, producing a morbidity ratio of 1.0 (95% confidence interval, 0.9 to 1.2). Significant increase for oral cancer was observed in male subjects, with a morbidity ratio of 5.9 (95% confidence interval, 2.5 to 11.4). This study indicates that patients with cutaneous lichen planus do not carry an increased risk of malignant transformation of the skin lesions or internally; however, there is increased risk of oral cancer.     

Verruköses spinozelluläres Karzinom auf Lichen ruber hypertrophicus

We report about a 64-year-old patient who developed a verrucous squamous cell carcinoma in a long-standing hypertrophic lichen planus of the right lower leg. Neoplastic transformation of hypertrophic lichen planus has rarely been described in the literature.     

Verrucous carcinoma in association with hypertrophic lichen planus

Neoplastic transformation of lichen planus is a rare event. However, squamous cell carcinoma may develop in 0.3%–3% of patients with the oral form of the disease. On the other hand, less than 30 cases arising in cutaneous lichen planus have been reported, and only four cases of verrucous carcinoma in association with either form, one with an oral lesion and three with cutaneous lesions (one hypertrophic and one ulcerative).
This report describes the unusual progression of a hypertrophic lichen planus plaque of the right leg to a verrucous carcinoma in a 40-year-old woman.     

Lichen ruber hypertrophicus with verrucous carcinoma]

A 51-year-old patient presented with aggregated papules and with a central, partly erosive plaque on the left lower leg. Histological examination revealed hypertrophic lichen planus peripherally and a verrucous carcinoma within the centre. The lesion was removed surgically. Shortly after wards an atrophic lichen planus developed exclusively within the skin graft, which was effectively treated with topical steroid cream. The patient remained disease-free for 2 years. The literature relating to malignant transformation of cutaneous lichen planus was reviewed. In most cases, as in the present one, the hypertrophic form of lichen planus and the verrucous type of carcinoma (Ackerman) are reported. Recent investigations have revealed human papilloma virus types 6 and 11 within such lesions.     

Metastatic cutaneous squamous cell carcinoma arising from a previous area of chronic hypertrophic lichen planus

Malignant transformation of cutaneous lichen planus is a rare event. We report a 34 year old Caucasian male who presented with an exophytic tumor on the right foreleg. The tumor gradually developed within previous areas of histologically proven hypertrophic lichen planus that had existed for about 10 years. However, the current histological examination of the excised tumor revealed highly differentiated squamous cell carcinoma with a depth of tumor invasion of 10 mm. At that time, neither sentinel lymph node biopsy nor further imaging diagnostics revealed evidence for metastatic spreading. Nevertheless, five months after surgery inguinal lymph node metastases were detected. Initial chemotherapy and inguinal lymph node dissection were unable to stop the spread of the tumor. One year later, parailiacal lymph node metastases were detected by computed tomography. Further cycles of chemotherapy resulted in significant reduction of the parailiacal tumor masses. This report indicates that the long-standing hypertrophic form of lichen planus seems to have a considerable propensity for malignant transformation, even in young patients.     

Verruk?ses spinozellul?res Karzinom auf Lichen ruber hypertrophicus

Lichen planus is a chronic mucocutaneous T-cell-mediated disease, whose cause is still unknown. The first case of lichen planus that transformed into squamous cell carcinoma was reported in 1903. We present three patients in whom squamous cell carcinomas were identified in chronic lichen planus. The world literature includes at least 91 cases, including our three cases. In an epidemiological study, no significant risk of transformation of cutaneous lichen planus into squamous cell carcinomas was found. In contrast, there is a significantly higher risk of malignant transformation in mucosal lichen planus, so that the WHO had graded mucosal lichen planus as a premalignant condition.     

Malignant transformation of oral lichen planus: case report and review of the literature

Lichen planus is a mucocutaneous disorder well known to both dermatologists and dentists. Traditional belief holds that oral lichen planus predisposes to the development of squamous cell carcinoma of the oral cavity. We present a case that illustrates such a malignant transformation in a patient who smoked and had actinically damaged skin.     

Lichen planus: a clinical and epidemiological study

Clinical and epidemiological data from 232 patients with lichen planus is presented. Lichen planus constituted 0.38% of the total dermatology, outpatients diagnosed. The patient ages ranged from 8 to 76 years, most being in the age range from 20 to 49 years. Duration of disease varied from 1 month to 7 years. Both sexes were equally affected. The majority of the patients (47.4%) had classical lesions followed by hypertrophic and actinic lichen planus next in frequency. Itching was the predominant symptom in 79.3%. Limbs were the most frequent initial site of onset (55.6%). Mucosal involvement along with cutaneous lesions were observed in 16.8% and genital involvement in only 5.2%. Nail changes were observed in 15.1% of patients. A history of recurrence of the disease was obtained from 10.3% of patients. Liver disease was found to be associated in 2.2% of patients. No malignant changes were observed in any of the lesions of lichen planus.     

Lichen nitidus of the palms: a case with peculiar histopathologic features

Palmar involvement in lichen nitidus is infrequent. In such cases, the histopathologic findings of palmar lesions are usually identical to those of extrapalmar ones. We report on the case of a patient with multiple tiny papules located on the palms and elbows. A biopsy specimen from the elbow showed the typical features of lichen nitidus, but a biopsy from the palm disclosed an inflammatory infiltrate mostly disposed around the bases of rete ridges and composed of lymphocytes and histiocytes with some giant cells both in the dermis and in the epidermis. This location of the infiltrate is similar to that found in hypertrophic lichen planus, a combination of lichen planus and lichen simplex chronicus. We conclude that this histopathologic feature in palmar lichen nitidus could be the result of the superimposition of lichen nitidus on normal palmar skin, resulting in a picture resembling hypertrophic lichen planus.     

Giant keratoacanthoma arising in hypertrophic lichen planus

A 45-year-old man presented with a rapidly enlarging tumour in an area of long-standing hypertrophic lichen planus of the lower leg. Histological examination of the resected specimen showed it to be a giant keratoacanthoma measuring 37 x 57 mm. Neoplastic change is a rarely reported complication of chronic variants of cutaneous lichen planus. To date there have been only two reports of keratoacanthoma development in association with lichen planus.     

Oral lichen planus in children: An Italian case series

Oral lichen planus usually occurs in adults; there are no clear data regarding the incidence and the clinical features of oral lichen planus in children. This paper reports clinical findings, treatments, and outcomes of 13 Italian patients with oral lichen planus in childhood diagnosed between 2001 and 2021. The most common finding was keratotic lesions with reticular or papular/plaque-like patterns, confined to the tongue in seven patients. Although oral lichen planus in childhood is rare and the malignant transformation index is unknown, specialists must be aware of its characteristics and oral mucosal lesions must be correctly diagnosed and managed.     

Premalignant nature of oral lichen planus

The issue as to whether oral lichen planus is a premalignant disorder is still controversial. This study aimed to examine oral malignancies associated with oral lichen planus and to investigate whether oral lichen planus has an intrinsic malignant potential or whether there are also contributing external risk factors. A retrospective cohort study in 200 Caucasian patients with oral lichen planus was conducted between 1991 and 2003. Aspects such as sex, age, clinical variant, affected anatomical sites, duration of the disease, histopathology, prior immunosuppressive treatment, exposure to potential carcinogens and other concomitant diseases were examined. Histopathological examination was repeated during the follow-up if a malignancy was suspected. Three (1.5%) of the 200 patients developed an oral squamous cell carcinoma at the same site following the initial diagnosis of oral lichen planus after a period of 3-6 years (mean 4.3 years). Contributing external risk factors were also noted in two of the three patients (smoking for 20 years and systemic immunosuppressive treatment for 2 years). The exact incidence of malignant transformation is difficult to establish, because of the low number of patients and because of the possible contribution of external risk factors, which may be relevant in oral malignancy.     

Widely Metastatic Squamous Cell Carcinoma Originating from Malignant Transformation of Hypertrophic Lichen Planus in a 24‐Year‐Old Woman: Case Report and Review of the Literature

Hypertrophic lichen planus (HLP) is a T‐cell‐mediated process typically presenting with hypertrophic or verrucous plaques on the lower limbs. We report the case of a 24‐year‐old woman with a history of HLP since age 3 years presenting with rapid malignant transformation of one lesion into a large squamous cell carcinoma (SCC). Subsequent examination revealed progressive, widespread metastatic involvement, and the patient ultimately died from her disease. SCC associated with HLP is rare, with a review of the literature revealing fewer than 50 cases. This case highlights the need to be aware of suspicious changes in HLP and to educate patients as to when to be reevaluated.     

New perspectives on the dynamic behaviour of oral lichen planus

Lichen planus, a chronic inflammatory disease that affects the skin and mucous membranes, is one of the most frequent dermatological disorders of the oral cavity. The prevalence of oral lichen planus ranges from 0.2% to 4%. The triggering factors remain unknown. Oral lichen planus can be considered to be a chronic disease of long duration with a dynamic evolution and frequent changes in clinical appearance. Three successive active stages can be distinguished, without sharp limits between them: an initial stage; a protracted intermediate stage with alternate periods of variable activity and quiescence, which carries a progressively increasing risk of malignant transformation; and a late stage that often ends in a clinically little-known, inactive cicatricial post-lichen stage, which does not respond to steroid treatment but retains the same risk.     

Evaluation of clinical types of cutaneous lichen planus in anti-hepatitis C virus seronegative and seropositive Nigerian patients

BACKGROUND: The presentation of oral lichen planus in anti-hepatitis C virus (HCV) seropositive and seronegative patients was previously evaluated, and the keratotic form of oral lichen planus was found to be more prevalent in anti-HCV seropositive patients. This study evaluated the presentation of cutaneous lichen planus in anti-HCV seropositive and seronegative Nigerians. METHODS: Fifty-seven Nigerians with cutaneous lichen planus were carefully examined to determine the form of lichen planus present. All were screened for the presence of anti-HCV by second-generation enzyme-linked immunosorbent assay (ELISA) and grouped as anti-HCV seropositive or anti-HCV seronegative patients. RESULTS: Nine patients were anti-HCV positive. Seven of these seropositive patients had hypertrophic lichen planus. CONCLUSION: Hypertrophic lichen planus in Nigerians is more prevalent with HCV infection.     

Hypertrophic Lichen Planus and Light Sensitivity in an HIV-Positive Patient

A 40-year-old black man who was HIV positive developed generalized hypertrophic lichen planus in areas previously affected by a photosensitivity eruption. After unsuccessful attempts to induce remission of his lichen planus with conventional therapies, etretinate produced a dramatic response.     

Vulval involvement in lichen planus: a study of 37 women

Summary The overall prevalence of vulval involvement in women with lichen planus is unknown. In a series of 37 women with lichen planus, we found vulval lesions in 19 (51%). Vulval lesions are often chronic and may undergo malignant change. All patients presenting with cutaneous or oral lesions of lichen planus should be questioned about, and examined specifically for, signs of genital involvement. Long-term follow-up of these patients is necessary.     

Hypertrophic lichen planus mimicking squamous cell carcinoma

An 87-year-old female presented with a 3 month history of hyperkeratotic nodules on her left shin. An initial clinical and histological diagnosis of multiple squamous cell carcinomas on the left shin was made. Review of the biopsy, however, showed hypertrophic lichen planus with pseudoepitheliomatous hyperplasia. Typical lichen planus was seen affecting the oral mucosa, nails and skin elsewhere.     

Verrucous lesions in patients with discoid lupus erythematosus

Seven cases of classical discoid lupus erythematosus of the face associated with hyperkeratotic, papulo-nodular lesions on the arms and hands were studied. Clinically the hyperkeratotic lesions resembled keratoacanthomas or hypertrophic lichen planus. The clinical course was marked by chronicity, an absence regression of the lesions, and resistance to treatment. Histopathologically, a lichenoid cellular reaction seemed to play a key role in the development of the hypertrophic lesions which resembled either keratoacanthomoas or hypertrophic lichen planus. Elastic fibres were prominent in the upper dermis, the lower levels of the epidermis and in the hyperkeratotic horny layer. Immunofluorescence of the papulo-nodular lesions demonstrated the deposition of IgG and IgM in a globular pattern at the dermal-epidermal junction. Discontinuous deposition of these antibodies was also seen at the basement membrane zone. On the basis of the immunofluorescence, histopathological and clinical studies, we suggest that the verrucous, hyperkeratotic lesions on the upper extremities represent an unusual, but distinct, form of discoid lupus erythematosus.     

Perforating lichen planus

We describe a case of perforating lichen planus. The foreign material eliminated by this path appears to be represented by the numerous hyaline bodies present at the base of the perforation. This unusual variant may be added to the many variants of lichen planus previously described: atrophic, hypertrophic, planopilaris, bullous, etc. . .