Oral leukoplakia developing on lichen planus: a case report of malignant transformation

Oral leukoplakia developing on lichen planus: a case report of malignant transformation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Oral leukoplakia developing on lichen planus: a case report of malignant transformation Pierre Klienkoff, Aron Khemis, Thibault Dedieu, Thibaut Wolf, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8974900/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Oral potentially malignant disorders (OPMDs), such as oral leukoplakia and oral lichen planus, are associated with an increased risk of malignant transformation to oral squamous cell carcinoma. The estimated malignant transformation rate for leukoplakia ranges from 6.64% to 9.5%, while oral lichen planus carries a lower but significant risk (0.7%–1.4%). Current decision trees, such as that proposed by van der Waal, recommend excision for dysplastic leukoplakia but are less clear for non-dysplastic lesions, particularly in the presence of additional risk factors. This case report highlights the importance of a risk-stratified approach in the management of OPMDs, emphasizing the need for early intervention in high-risk patients to prevent delayed cancer diagnosis. Case Presentation: A 73-year-old male, with a history of 19 pack-years of smoking (quit in 1984) and bilateral oral lichen planus, was referred for evaluation of asymptomatic white reticular lesions on the buccal mucosa. After 1 year of follow-up, a new homogeneous, asymptomatic white keratotic plaque appeared on the left lateral border of the tongue. Biopsy confirmed leukoplakia superimposed on oral lichen planus. Despite the absence of dysplasia on initial biopsy, the lesion was excised due to its high-risk location and the patient’s cumulative risk factors (size >200 mm², tongue location). Histopathological analysis of the excised specimen revealed an in situ squamous cell carcinoma (cT1N0M0). The patient underwent partial glossectomy with clear margins. At the 1-year postoperative follow-up, he exhibited a mature linear scar with no signs of recurrence and preserved tongue mobility, demonstrating minimal functional sequelae. Conclusions: This case underscores the importance of considering cumulative risk factors—such as lesion size, location, and the presence of multiple OPMDs—in the management of oral leukoplakia. We propose a modification to the van der Waal decision tree: excision of non-dysplastic leukoplakia in patients with ≥1 risk factor, rather than universal surveillance. Early surgical intervention in high-risk cases may facilitate the detection of carcinoma at earlier stages, improving patient outcomes and reducing the need for more invasive treatments. Further studies are needed to validate the inclusion of multiple OPMDs as an independent risk factor in clinical decision-making. Oral leukoplakia Lichen Planus Oral potentially malignant disorder Oral squamous cell carcinoma Malignant transformation Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 06 Apr, 2026 Reviews received at journal 19 Mar, 2026 Reviews received at journal 15 Mar, 2026 Reviews received at journal 11 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers agreed at journal 06 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers invited by journal 05 Mar, 2026 Editor invited by journal 03 Mar, 2026 Editor assigned by journal 02 Mar, 2026 Submission checks completed at journal 02 Mar, 2026 First submitted to journal 26 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8974900","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":603594134,"identity":"1ec1c408-44d7-468c-af52-fa891a528c97","order_by":0,"name":"Pierre 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The estimated malignant transformation rate for leukoplakia ranges from 6.64% to 9.5%, while oral lichen planus carries a lower but significant risk (0.7%–1.4%). Current decision trees, such as that proposed by van der Waal, recommend excision for dysplastic leukoplakia but are less clear for non-dysplastic lesions, particularly in the presence of additional risk factors. This case report highlights the importance of a risk-stratified approach in the management of OPMDs, emphasizing the need for early intervention in high-risk patients to prevent delayed cancer diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation:\u003c/strong\u003e A 73-year-old male, with a history of 19 pack-years of smoking (quit in 1984) and bilateral oral lichen planus, was referred for evaluation of asymptomatic white reticular lesions on the buccal mucosa. After 1 year of follow-up, a new homogeneous, asymptomatic white keratotic plaque appeared on the left lateral border of the tongue. Biopsy confirmed leukoplakia superimposed on oral lichen planus. Despite the absence of dysplasia on initial biopsy, the lesion was excised due to its high-risk location and the patient’s cumulative risk factors (size \u0026gt;200 mm², tongue location). Histopathological analysis of the excised specimen revealed an in situ squamous cell carcinoma (cT1N0M0). The patient underwent partial glossectomy with clear margins. At the 1-year postoperative follow-up, he exhibited a mature linear scar with no signs of recurrence and preserved tongue mobility, demonstrating minimal functional sequelae.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e This case underscores the importance of considering cumulative risk factors—such as lesion size, location, and the presence of multiple OPMDs—in the management of oral leukoplakia. We propose a modification to the van der Waal decision tree: excision of non-dysplastic leukoplakia in patients with ≥1 risk factor, rather than universal surveillance. Early surgical intervention in high-risk cases may facilitate the detection of carcinoma at earlier stages, improving patient outcomes and reducing the need for more invasive treatments. 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