Oral lichen planus is usually a reticular, bilateral, symmetrical pattern of white lace-like striae. Changes that should prompt a biopsy include a lesion that becomes thickened, nodular, indurated or fixed, a persistent ulcer that fails to heal with treatment, a red or speckled area, and asymmetrical or unilateral involvement. Ask about tobacco, betel quid and alcohol, which add to the risk and are common in India. Refer early to oral medicine or ENT when in doubt.
- Biopsy oral lesions that become thickened, nodular, indurated or fixed.
- Biopsy a persistent ulcer or a red or speckled area within lichen planus.
- Treat unilateral or asymmetrical 'lichen planus' with suspicion.
- Ask about tobacco, betel quid and alcohol use at every review.
Why it matters
Early oral cancer within lichen planus is easily mistaken for a flare.
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