Oral lichen planus (OLP) is classified among precancerous conditions, as it
is considered a generalized state associated with a significantly increase
d risk of cancer. The objective of this study was to discuss ultrastructura
l aspects of OLP that could play a role in enhancing metastatic potential,
thus worsening the prognosis in oral squamous-cell carcinoma (OSCC). We rep
ort four cases of microinvasive OSCC which have occurred in OLP patients. A
ll of them were stage I tumors, with a mean thickness of 1.75 mm. Recent st
udies indicate a tumor thickness over 4 mm as predictive of nodal metastase
s, but within 6 mo, our four patients with OSCC arising from OLP developed
lymphnodal metastases. Our findings suggest that OLP-related OSCC may have
a worse prognosis because of increased metastatic potential; obviously, fur
ther investigation is required, but this preliminary evidence emphasizes th
at extremely careful management of OLP patients is mandatory, and in cases
of OSCC arising from OLP, a more radical treatment is probably required.