OLP Malignant Transformation — ORE Part 1 MCQ

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EasyOral MedicineOLP Malignant TransformationORE Part 1

A patient with newly diagnosed oral lichen planus asks about malignant transformation risk. What is the approximate malignant transformation rate of oral lichen planus?

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Correct answer: C — Approximately 1–2% over a lifetime

Oral lichen planus (OLP) is classified as a potentially malignant disorder, but with a *low* transformation risk. Current UK guidance (NHS HRA) and robust meta-analyses support an overall malignant transformation rate of approximately 1–2% over a patient's lifetime (equating to ~1% in 7 years or <0.5% annually for non-dysplastic lesions). Individual UK cohort studies report 1.9%. This risk is significantly lower than common misconceptions (50%, 30%, or 20%) but higher than zero. Patients with erosive OLP, tongue involvement, smoking, alcohol use, or hepatitis C infection carry higher individual risk and warrant more frequent specialist follow-up.

Reference: UK Health Research Authority: Malignant Transformation in Oral Lichen Planus (https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/malignant-transformation-in-oral-lichen-planus/); Aghbari et al. Oral Oncology. 2017;68:92–102 (meta-analysis, 19,676 patients, 1.1% pooled rate).