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Lichen planus — SCE Dermatology MCQ

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HardDermatopathologyLichen planusSCE Dermatology

A woman with biopsy-proven erosive oral lichen planus attends surveillance. One lateral-tongue erosion has become indurated, bleeds on contact and has persisted despite otherwise effective topical treatment. What should happen next?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Biopsy the changing focus and submit it for dysplasia and squamous-carcinoma assessment

Explanation lettering: E = shown as B · D = shown as C · B = shown as D · C = shown as E

A is correct. Oral lichen planus has a small but clinically meaningful risk of malignant transformation. A persistent, changing, indurated or bleeding focus requires targeted examination and biopsy even when the background diagnosis has already been confirmed. The previous biopsy does not determine the histology of a new focal change. Prolonged escalation of topical treatment would delay diagnosis, candidal treatment cannot explain away induration, and destructive therapy without tissue would remove the opportunity for histological assessment. Continued oral and dental surveillance, tobacco and alcohol risk review and treatment of symptomatic lichen planus remain appropriate after the focal lesion is investigated.

Reference: BAD oral lichen planus information: https://www.bad.org.uk/pils/oral-lichen-planus