Coexisting oral potentially malignant disorders as a candidate risk factor for malignant transformation: a case report and proposal for a modified leukoplakia decision tree
Pierre Klienkoff, Aron Khemis, Thibault Dedieu, Thibaut Wolf, Sophie Bahi-Gross, Lucas GeyerIntroduction:
Oral potentially malignant disorders (OPMDs), including leukoplakia and oral lichen planus, carry an increased risk of malignant transformation to oral squamous cell carcinoma, with reported rates of 6.64–9.5% for leukoplakia and 0.7–1.4% for lichen planus. Current decision trees recommend excision whenever feasible and do not stratify non-dysplastic lesions by risk factors, nor do they address whether the coexistence of multiple OPMDs should itself lower the threshold for intervention.
Case presentation:
This report describes the case of a 73-year-old man with pre-existing oral lichen planus who developed a new, non-dysplastic leukoplakic plaque on the lateral border of the tongue. Despite the absence of dysplasia on initial biopsy, the lesion was excised in light of the lesion’s high-risk features and the patient’s coexisting OPMDs. Histopathology of the excised specimen unexpectedly revealed an
Discussion:
Prompted by this case, the coexistence of multiple OPMDs is proposed as a candidate risk factor (hypothesis) that could be incorporated into the leukoplakia management algorithm, supplementing existing decision trees with a branch that stratifies non-dysplastic lesions by risk factors.
Conclusion:
This case-based framework is intended to be hypothesis-generating and warrants validation in larger cohorts.