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Red lesions: autoimmune and malignant conditions
Published on March 30, 2017 40 min
Other Talks in the Series: Oral & Maxillofacial Medicine
Lumps and bumps in the mouth and lips
- Dr. Nicholas Kalavrezos
- University College London Hospital, UK
Lumps and swellings of the salivary glands 1
- Prof. Emeritus John D. Langdon
- King’s College London, UK
Sensory and motor deficits
- Dr. Dimitris Malamos
- National Organization of Health Service (IKA), Greece
Soreness and ulcers 1: recurrent ulcers due to aphthae and aphthous-like ulcers
- Prof. Camile Farah
- School of Dentistry - University of Western Australia, Australia
White lesions - oral leukoplakia, a premalignant lesion
- Prof. Palle Holmstrup
- University of Copenhagen, Denmark
The next component of this presentation will deal with non-neoplastic inflammatory diseases highlighted by lichen planus. We will segue through other inflammatory conditions which are immune-mediated and terminate with precancer and cancer, highlighted by the initial erythroplasia, a highly worrisome problem that leads to, in most cases, squamous cancer or severe precancerous changes.
So we will begin with discussing lichen planus and its various forms. This can be a serious chronic problem involving the oral cavity alone or can involve the skin and other sites, including those of the areas of the scalp, flexor surface of the forearms, the pretibial region of the legs, gynecological involvement, scalp involvement, nail involvement, esophageal involvement. So this is not necessarily an oral disease only by any means.
Several facts about lichen planus, up to 1% of the population is affected. And those numbers will vary depending upon the literature sources you choose to quote. As evidenced in my practice, most of my lichen planus patients tend to be women, half or more of cutaneous lichen planus can accompany oral lichen planus in women. Average age of onset of oral lichen planus tends to be middle-aged years. The duration of the problem before attention is drawn to it can vary from weeks to months to years, in fact, and there are variable clinical presentations which we will demonstrate.
Depending upon your sources, you will see reference to how many cases are seen with concomitant skin lichen planus, and this varies from 20% to 34%, some patients have only oral lesions, some patients have only skin lesions, but basically, be aware of the fact that this is basically a mucocutaneous disease, not just an oral disease. As noted earlier, lichen planus can affect the esophagus, the urinary bladder, the nasal mucosa, the scalp, the eyes, the stomach, larynx, anus, and genitalia. Perianal itching is a commonly noted form of lichen planus which must be addressed. In women, vaginitis of one sort or another must be separated from the genital form of lichen planus. Importantly, the lichen planus cases involving the attached gingiva carries a differential diagnosis with desquamation as the common feature in all of those gingival lesions which we will go into in some detail.