A retrospective survey of oral lichenoid lesions: Revisiting the diagnostic process for oral lichen planus

Objective. We sought to investigate patient demographics and diagnostic trends in biopsies in patients with final diagnoses of oral lichen planus or lichenoid over 4 decades. Methods. Archived biopsy reports from 248 patients were examined for 1966, 1976, 1986, and 1996. Data were collected for patient age and sex, significant medical and dental history, description of lesion, and clinical and histopathologic diagnoses. Results. Oral lichen planus made up a declining portion of total final diagnoses over the decades. The number of cases with less-than-definitive diagnoses and using modifying terminology (eg, probable, possible, suggestive of) increased. In addition, the age at diagnosis for female patients increased by 1.2 years per decade on average, whereas the age for male patients decreased by 3.5 years per decade on average. Conclusions. The diagnosis of oral lichen planus appears to have been extended by the use of modifying terminology to include lesions that have less than definitive features. Comprehensive clinical histories and investigations can help limit the inclusion of such lesions.