Evaluation of oral epithelial dysplastic features in oral lichen planus: The diagnostic difficulties

Background: Lichen planus (LP) is chronic, mucocutaneous, autoimmune disease which can affect oral mucosa, skin, scalp, nails, and genital mucosa. The prevalence of oral LP (OLP) varies with different geographic distribution. It presents symmetrical and bilateral or multiple lesions with varying clinical types accompanying with burning sensation and sometimes pain. Due to its potentially malignant nature, the evaluation of cell proliferation brings important information regarding diagnosis and prognosis of several types of cancer. Materials and Methods: Sixty-four cases of OLP were retrieved and were histologically assessed under 10× and 40× magnifications for valuation of the dysplastic features. The grading was done by the criteria followed by Odukoya et al. The data obtained were tabulated and subjected for the statistical analysis. Results: Epithelial dysplasias were observed in 60 cases of OLP which Grade I had 9 cases, Grade II 27 and Grade III 24 cases. Four cases of OLP did not show any dysplasia. The interrater reliability was found to be in strong or substantial agreement in assessing few of the dysplastic features. Male:female ratio was 1.2:1 with buccal mucosa being the most common site. Conclusion: Our study showed the importance to establish a correct diagnosis of OLP based on the history, clinical presentations, and histopathology. Furthermore, the long-term follow-up of the patient with OLP is mandatory when dysplasia is encountered on histopathology.