Initial Presentation of Proliferative Verrucous Leukoplakia May Simulate Lichenoid Lesions

Objectives: The aim of this study was to correlate the clinical and histopathological characteristics of patients who were diagnosed in a first moment with lichen planus or lichenoid reaction and, throughout the follow-up, evolved with multifocal white plaques, compatibles with proliferative verrucous leukoplakia (PVL).
Methods: It was selected 5 patients with a current diagnosis of PVL that were, initially, diagnosed with lichen planus or lichenoid reaction in buccal mucosa or tongue. Clinical and histopathological records of these patients were reviewed and its features were correlated.
Results: The mean age of these 5 patients were 63.4 years (range: 52-77); being 1 male and 4 females; and all of them were non-smoker. Four of them (80%) presented bilateral lesions at first biopsy and the histopathological diagnosis was lichen planus in 4 (80%) and lichenoid reaction in 1 patient (20%). After a median time of 5.2 years (range: 1 – 8), the patients evolved with multifocal white plaques, clinically compatible with PVL. Three patients (60%) presented non-homogeneous leukoplakias whilst 2 patients (40%) presented homogeneous clinical features. Other biopsies were performed and histopathological analysis showed hyperkeratosis and acanthosis without dysplasia in 3 cases (60%) and 2 patients (40%) presented mild dysplasia. There were no cases of malignant transformation.
Conclusions: PVL may present a lichenoid pattern mainly in the initial clinical presentations, which may even be confirmed by the histopathological study. The spectrum of PVL may present both the white and the erythematous component and, when these lesions affect the buccal mucosa and the lateral border of the tongue, it may be challenging to differentiate them from lichen planus or lichenoid lesions.