Malignant transformation of oral lichen planus: A peril of covid-19 pandemic

ABSTRACT

Oral Lichen Planus (OLP) is a chronic autoimmune inflammatory disease of the oral mucosa. The erosive variety of OLP is multifocal, ulcerative, and painful in nature. Patients with OLP have a higher risk of developing Oral Squamous Cell Carcinomas (OSCCs). A 49-year-old female patient presented to the Department of oral medicine and radiology with the chief complaint of burning sensation in the inner aspect of right cheek, since one year. A diffuse whitish area surrounded by erythematous area was present in the right buccal mucosa. Lesion was diagnosed primarily as erosive Lichen Planus (LP). She discontinued the medication and did not come for follow-up visits because of the Coronavirus Disease 2019 (COVID-19) pandemic. After 10 months she came back with pain and a diffuse swelling with indurated margin, in the same region involving right buccal vestibule and retromolar area. After incisional biopsy it was found that the lesion has progressed to squamous cell carcinoma, and the patient was referred to the Department of Oral Surgery where segmental mandibulectomy was done with placement of free fibula graft. The OLP is considered as a potentially malignant disorder and patient should be advised to avoid additional risk factors such as tobacco and alcohol and should be followed at minimum a year interval as prognosis and patient survival is directly related to stage and grade of cancer at its initial diagnosis.