The natural history of oral mucosal lesions with both lichenoid and epithelial dysplastic features: a systematic review

Background: Assessing the natural history of oral mucosal lesions with both lichenoid and epithelial dysplastic features through a systematic review of published literature. Methods: Scopus, PubMed, and Web of Science were searched for oral mucosal lesions showing both lichenoid and epithelial dysplastic features from original studies using the keywords "oral lichenoid dysplasia; oral epithelial dysplasia (OED) with lichenoid features; oral lichen planus (OLP) with dysplastic features; oral lichenoid lesions (OLL) with dysplastic features". Results: The search yielded 152 articles (PubMed-84, Scopus-32, Web of Science-36). Among these only 5 studies complied with the selection criteria including the provision of sufficient clinical and histopathological data. Out of these 5 studies, 181 cases were described to exhibit both lichenoid and epithelial dysplastic features. The most common diagnostic criterion employed was of van der Meij et al. Although some studies accepted the presence of epithelial dysplasia in OLL, most rejected the notion of epithelial dysplasia in OLP and designated such lesions as an OLL or oral lichenoid dysplasia. The few studies which accepted the presence of epithelial dysplasia in OLP rendered a diagnosis of OLP with dysplasia. Conclusions: The review shows that several diagnoses were used for lesions with similar clinicopathological features and distinct clinicopathological entities were designated similar diagnosis. These diagnostic variations are the primary cause for the discrepancies in the prevalence and malignant transformation rates of these enigmatic entities which in turn often leads to erroneous treatment.