ABSTRACT
(1) Objective: To review the criteria proposed by Cerero-Lapiedra et al. and to retrospectively identify the under-diagnosed disease in patients diagnosed with proliferative verrucous leukoplakia. (2) Materials and methods: In this study, we included patients who were diagnosed with leukoplakia (histological label consistent with the clinical diagnosis, n = 95), and cases with a final diagnosis within the spectrum of proliferative verrucous leukoplakia (n = 110) as defined by Batsakis et al. We applied the criteria proposed by Cerero-Lepiedra et al. to screen for the possible cases of proliferative verrucous leukoplakia. (3) Results: Although many of our patients satisfied specific isolated criteria, only 11 cases satisfied specific combinations of the guidelines to satisfy a diagnosis of proliferative verrucous leukoplakia. However, due to the lack of follow-up data, the disease is not confirmed in these 11 cases. (4) Conclusion: A limited number of cases of proliferative verrucous leukoplakia were diagnosed using the criteria given by Cerero-Lapiedra et al. The true natural history of the disease could not be studied due to the lack of follow-up data. (5) Clinical relevance: Proliferative verrucous leukoplakia presenting as hyperkeratosis or mild epithelial dysplasia are often not followed up, and they subsequently transform into carcinoma. Thus, clinicians must be vigilant whenever they encounter leukoplakia, especially with multifocal presentations. In such cases, the follow-up data are the key to understanding the true nature of the disease entity.
ABSTRACT
AIM: In the present study, we simulated clinical scenarios by explicitly describing the history and clinical and histological features of hypothetical patients presenting with oral lichen planus (OLP), oral lichenoid lesion, and epithelial dysplasia in a self-designed questionnaire. By doing so, we aimed to elicit a diagnosis from oral pathologists and trainees, analyze their responses, appraise issues, and propose solutions regarding the diagnosis of OLP. METHODS: The questionnaire was distributed to 100 oral pathologists and trainees in South India. Six questions were designed to assess awareness of the diagnostic aspects of OLP. Ten questions were hypothetical clinical scenarios (HCS) devised to evaluate respondents' knowledge of diagnostic guidelines and the criteria used by the respondents to render a diagnosis. RESULTS: There were 60 of 100 responses to the questionnaire. More than half the respondents were aware of the World Health Organization and modified guidelines of OLP. We observed considerable variations in diagnoses for the HCS. CONCLUSIONS: Our study illustrates the ambiguity in rendering an accurate diagnosis, despite adequate guidelines. Based on the responses for the HCS, we hypothesized that changes in the distribution (unilateral or bilateral) and clinical characteristic of OLP, and habits of patients, have a significant bearing on the clinical and final diagnoses of the lesion.
Subject(s)
Clinical Competence , Lichen Planus, Oral/pathology , Health Care Surveys , Humans , India , Pathology, Clinical , Pilot ProjectsABSTRACT
Despite guidelines for the diagnosis of oral lichen planus (OLP), there has been much difficulty and ambiguity in rendering a straightforward diagnosis. The root of the problem might arise in not following universal guidelines and being too rigid and unilateral in making a diagnosis. Because of its autoimmune pathogenesis, the dynamic nature of OLP has further fueled confusions. This has had repercussions in the form of controversies in its diagnosis, treatment protocols, research, and most importantly, its potentially malignant nature. Oral lichenoid dysplasia (OLD), an enigmatic entity, proposed by Krutchkoff and Eisenberg, has not found universal acceptance by the pathology community. The objective of the present review was to outline these debates and discuss ongoing controversies regarding OLD and uncertainties in the diagnostic criteria of OLP.
