Prevalence and Malignant Potential of Oral Lichenoid Dysplasia- Systematic Review

Objectives: To determine the prevalence and malignant transformation rate of oral lichenoid dysplasia (OLD) among published cases with both dysplastic and lichenoid features.
Methods: PRISMA guidelines strictly adhered. Google Scholar, PubMed, Web of Science and Embase were searched for the keywords "Oral lichenoid dysplasia or oral epithelial dysplasia with lichenoid features or oral lichen planus with dysplastic features or oral lichenoid lesions with dysplastic features". Only original research, case reports, and case series in English language providing sufficient clinicopathological details of cases exhibiting both dysplastic and lichenoid features were included. Diagnostic criteria used for recategorizing misdiagnosed lesions are as follows: Lesions with features typical of oral lichen planus (OLP) but with dysplasia were categorized as OLP with dysplasia, lesions not typical but compatible with OLP with dysplasia were categorized as OLD. Lesions either typical or compatible with OLP with a history of a potential triggering agent were categorized as oral lichenoid lesions (OLL). Using the above criteria, misdiagnosed cases were recategorized, following which the prevalence and malignant transformation rate were assessed.
Results: Database revealed 157 articles, out of which 58 duplicate articles were excluded. Among the 99 articles assessed, only 11 articles (151 cases) complied with the inclusion criteria. Out of the 151 cases, 69 lacked essential data for a diagnosis, 75 were OLD, 6 were OLP with dysplasia, and 1 was OLL with dysplasia. On follow up 4 OLD cases exhibited malignant transformation.
Conclusions:
It is vital to establish universal diagnostic criteria for OLD and related lesions to prevent misdiagnosis and enable uniform reporting which in turn will provide an accurate depiction of the global prevalence and malignant transformation rate of OLD, OLP, and OLL.