The Lichen Planus and Oral Cancer Connection

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    March 6, 2023 8:09 AM EST

    The Lichen Planus and Oral Cancer Connection

    Lichen planus is a disease that can occur on the skin or inside the mouth. While doctors don't know the cause of lichen planus, they do know that it is a noninfectious disease, meaning you can't catch it or spread it. They also know that it lasts a long time and tends to come back.

    Lichen planus is classified as an autoimmune disease. Autoimmune diseases occur when the body's defense system, made up of white blood cells that usually fight off infections, attack normal parts of the body.

    Lichen planus of the skin usually causes red, itchy bumps, and as the bumps heal they may leave brown spots behind. Allergic-type reactions to some blood pressure, heart, and arthritis medications can cause lichen planus. In these cases, once the medication is stopped, lichen planus goes away.

    Understanding Oral Lichen Planus

    Oral lichen planus can occur anywhere inside the mouth, but is usually seen on the inside of the cheeks and appears as thin white lines, patches, or dots. It is most common between the ages of 30 and 60. While it appears in about one to two percent of the population, women get oral lichen planus twice as often as men.

    Lichen Planus and Mouth Cancer

    Oral lichen planus that appears as white spots or fine lines is probably not related to mouth cancer, but in about 40 percent of cases a more serious type develops. This "erosive" lichen planus causes painful sores and ulcers in the mouth. It's possible that about 1 percent to 5 percent of these cases may turn into oral cancer.

    "We commonly see lichen planus inside the cheeks of women, and this is not the population or the area where we see oral cancer," says William M. Lydiatt, MD, director of head and neck surgical oncology at University of Nebraska Medical Center. "It may be that the erosive form combined with longstanding chronic irritation can become oral cancer, but the evidence is not very strong."

    While lichen planus very rarely leads to oral cancer, irritation of lichen planus by tobacco and alcohol, poorly fitting dentures, and poor oral hygiene can turn lichen planus into the erosive type. It is probably the combination of these irritants over time along with erosive lichen planus that leads to oral cancer.

    Managing Lichen Planus

    Once you have been diagnosed with oral lichen planus, you should be checked by an oral specialist two to four times a year. Your doctor will make note of any changes and take some tissue to look at under the microscope if necessary to make sure there are no signs of oral cancer. It's also important to get regular dental care and maintain good oral hygiene. Although there is no medication to cure the condition, treatments are available to relieve the soreness of erosive lichen planus. Ask your doctor or dentist what they recommend.

    If you have lichen planus, you should also be careful to avoid:

    All tobacco and alcohol products. These can cause lichen planus to become more serious and may lead to oral cancer. Do not drink alcoholic beverages or use any mouthwash solutions that contain alcohol.

    Stress. Some doctors believe that there is a relationship between stress and flare-ups of lichen planus. And stress management is always a good thing; so take steps to manage your stress levels and you may reduce your risk of lichen planus while you enjoy a more relaxed outlook on life.

    Taking precautions and getting routine checkups will go a long way toward relieving worries about lichen planus and may help prevent those rare cases of mouth cancer from developing.

    Sofia Perez will never forget her husband’s reaction two years ago to the news that she had stage 2 breast cancer.

    “Although he could sense something wasn’t right as soon as we sat down in our living room, he didn’t ask any questions until after I told him what was going on,” she says.

    His reaction after that brought tears to her eyes.

    “He held me tightly while reassuring me that everything would be okay and that we would make it through this together no matter what happened next or how difficult things might become along the way,” says Perez, now 42.

    Her husband’s response was exactly right, notes Jennifer Gregg, PhD, a clinical psychologist in the Bay Area and an associate professor of psychology at San Jose State University in California.

    “Listening and expressing support is what a partner needs to do when a breast cancer diagnosis is first shared,” Dr. Gregg says.

    Perez was wise, too, in being direct and explaining the situation soon after she was diagnosed without getting too deep in the weeds about her treatment or prognosis, Gregg adds.

    Breaking the news that you’ve got cancer can feel overwhelming, which is why Gregg recommends that you first think about your feelings, “so you walk into the discussion with an awareness of them.”

    Expressing what you need is also helpful, she adds. “Do you want the person to check in with you about the process, or wait for you to bring it up? Or do you want an ear to talk to, or somebody to help you cope by helping you see the bright side?” Either way, it’s best to think about your own intentions and what you want.

    “It’s important to note that, at first, men may need fewer specifics on things like surgery options or staging,” she says. “They may need more information, instead, about how you’re feeling, what your worries are, and what they need to do to support you.”

    Then, once your partner begins asking for details, like whether you’ll need chemotherapy or radiation, or if you’re going to lose your breast, it’s always ideal to be direct in your answer.

    “Saying something like, ‘I don’t know exactly what’s going to happen yet’ is one way to go about this,” Gregg says. “You can also add, ‘This might be hard for you, sweetie. I want to make sure that if I end up needing a mastectomy that you get support about this,’ which gives your partner permission to request their own support.”

    You also want to do your best to keep all the lines of communication open even when you don’t have all the answers.

    “Lots of times partners feel like they can’t ask questions or they shouldn’t react in any way that might make them seem less sympathetic,” Gregg says. “We find that men are worried about coming off as a jerk, so they don’t express their concerns or struggles, and that’s not great, either.”

    How to Talk About Hereditary Risk
    Since a breast cancer diagnosis may have implications for male family members, it’s also important to discuss hereditary risk, according to Mary Dev, LCSW, a senior social work counselor at MD Anderson Cancer Center in Houston. This is especially critical if you’ve had genetic testing that revealed you’re a BRCA1 or BRCA2 gene carrier.

    “Once you know what your genetic situation is, be honest with your family, including the men in your family,” Dev says. “While many families and cultures don’t talk about this, you don’t want your family members to be blindsided by something that has been in your family tree all along.”

    Again, keep the explanation simple. “Say something like ‘This is my situation,’” she says. “‘It’s now part of our family history, so we need to see if anyone else in the family is at risk. This will help us make other decisions if needed.’”

    How to Ask for Help
    When it comes to asking for help from the men in your family, don’t expect anyone to read your mind and know exactly what you need.

    “Most people want to help out,” Dev says. “They may just need direction; so, if your husband isn’t a good cook, maybe he can find a way to outsource this among friends and neighbors.”

    Throughout the process, touch base with the men in your life frequently, Dev recommends. For example, if you want them to come to your doctor’s appointments and treatments, make that clear.

    “When couples don’t talk that’s a red flag,” Dev notes. “You want to be sure to continue talking about your concerns, which will keep changing throughout your breast cancer experience.”

    This includes being honest with your partner about how your breast cancer is affecting your relationship.

    “Be honest if you fear it will affect your sex life, and don’t assume that it will be a turnoff for your partner,” Dev says. “The more you communicate, the more information you’re giving your partner to support you.”

    Or, just follow Perez’s husband’s lead.

    “He showed immense strength during such a vulnerable time by being there for me without fail,” says Perez, who finished treatment two months ago and is now in remission. “From helping me make appointments for doctor’s visits, providing comfort where needed or simply listening, his support meant more than anything else in those moments of uncertainty and fear following my diagnosis.”