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What are the changes on squamous cell carcinoma in oral lichen planus?

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Posted on Tue, 1 Dec 2015
Question: Please forward this question to Dr. XXXXXXX Hanif
This is related to Oral Lichen planus

Here are the pictures of OLP. I have attached. This is different thread

Thank you very much

The first two are today's photo shots, the January 2015 are the old ones. You can see OLP was just started then back in January, there was lot of pain, see the reticular lines and redness. The latest pictures shows almost fading of the reticular lines and cleaner mucosa.

what are the changes on SCC in olp ?. I have read over 200 articles on those. There is lot of controversies around if OLP is real cause of SCC. I had seen 3 oral surgeons back then, most had said it is not clear if OLP is the root cause for SCC. It could be something else. Also Homeopath is very famous in OLP and has seen over 4000 cases in the past. He told me it does not appear to be anything that I should get another biopsy based on clinical and present look and feel. There is no need to biopsy every year unless clinical signs warrant that.

I will see oral surgeon to find out his opinion and see if another biopsy is needed. I may have to pay out of pocket for that. My insurance has changed and it gets harder to do biopsies unless primary care physicians recommends it. I will need referral for oral surgeon since I have HMO. I hate HMO's, and that's why everything I have to go through promary care physician, the cycle gets longer, many times the surgeons I had seen in the past are out of network. It's just big pain to get anything done

Please take a look and let me know

Thank you
doctor
Answered by Dr. Muhammad Hanif (1 hour later)
Brief Answer:
I have a different belief to the Homeopath !!!

Detailed Answer:
Welcome back Mr. XXXX and thanks for the consultation at my virtual clinic!

NOTE:-
I will answer you answer in simple words to clarify my point and I will Copy-Paste your query and will answer step by step so that nothing is left behind unanswered.


(((what are the changes on SCC in olp ?
***There are different research connections emphasizing that every patient should go for yearly screening for SCC if he has got OLP. It is in the best interest of the patients and is a good preventative approach and in this way we can save a patient from potential cancer needing surgical resection and complications can be avoided. So it is in common practice and I also have the same school of thought on this issue.***

((( I have read over 200 articles on those. There is lot of controversies around if OLP is real cause of SCC. I had seen 3 oral surgeons back then, most had said it is not clear if OLP is the root cause for SCC. It could be something else. Also Homeopath is very famous in OLP and has seen over 4000 cases in the past. He told me it does not appear to be anything that I should get another biopsy based on clinical and present look and feel. There is no need to biopsy every year unless clinical signs warrant that.)))
***Yes it is not 100% fix rule to go for biopsy but as I said it is better to go for yearly biopsy to remain on the safe side.

I have reviewed and can see in pictures that you have a much improved lesions now. It is better looking than before.

((( I will see oral surgeon to find out his opinion and see if another biopsy is needed. I may have to pay out of pocket for that. My insurance has changed and it gets harder to do biopsies unless primary care physicians recommends it. I will need referral for oral surgeon since I have HMO. I hate HMO's, and that's why everything I have to go through primary care physician, the cycle gets longer, many times the surgeons I had seen in the past are out of network. It's just big pain to get anything done)))
***Yes I am of the same view. HMO has got some issues that bother a lot of patients and many Physicians don't accept this insurance due to its limitations. But you may call a Surgeon and ask if he is in the network and then get referred to him through your PCP.





Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with expert opinion. Please don't forget to give Five Star rating to help me assist my patients in a better way; and, please don't forget to 'Close This Discussion'.
For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).


Regards!
DR. XXXXXXX HANIF
USA

Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Muhammad Hanif (1 hour later)
I will try to see oral surgeon I had seen to understand what he says. If he says no need of BIOPSY based on clinical presentation, should I insist on biopsy ?. Now I am confused.

Please advise.
doctor
Answered by Dr. Muhammad Hanif (35 minutes later)
Brief Answer:
No---If he says no need for biopsy then in the good faith you should accept

Detailed Answer:
Thanks for the consultation at my virtual clinic!
I have carefully worked through your case, and can well realize your health worries. Being your physician, I will take care all of your medical concerns today and will put my best efforts to get you out of this situation.


If he says not to go for a biopsy after his careful evaluation, then my suggestion will be to accept his words in the good faith. Physical evaluation of the tissue especially in case of OLP can tell you if you need or not a biopsy right now. Please don't get confused as there are two school of thoughts. One says go for yearly biopsy. Other says go for a checkup on regular basis and decide if biopsy is needed.

If we follow the first school of thought---Almost no SCC can go undiagnosed.
If we follow second school of thought--Patient may or may not have gone for serial examination; The Physician may miss a diagnosis on physical examination and you were solely on the discretion of the physician. So you should choose a good Physician for that. Choice is yours.


Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with expert opinion. Please don't forget to give Five Star rating to help me assist my patients in a better way; and, please don't forget to 'Close This Discussion'.
For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).


Regards!
DR. XXXXXXX HANIF
USA

Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
Answered by
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Dr. Muhammad Hanif

General & Family Physician

Practicing since :2009

Answered : 2369 Questions

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What are the changes on squamous cell carcinoma in oral lichen planus?

Brief Answer: I have a different belief to the Homeopath !!! Detailed Answer: Welcome back Mr. XXXX and thanks for the consultation at my virtual clinic! NOTE:- I will answer you answer in simple words to clarify my point and I will Copy-Paste your query and will answer step by step so that nothing is left behind unanswered. (((what are the changes on SCC in olp ? ***There are different research connections emphasizing that every patient should go for yearly screening for SCC if he has got OLP. It is in the best interest of the patients and is a good preventative approach and in this way we can save a patient from potential cancer needing surgical resection and complications can be avoided. So it is in common practice and I also have the same school of thought on this issue.*** ((( I have read over 200 articles on those. There is lot of controversies around if OLP is real cause of SCC. I had seen 3 oral surgeons back then, most had said it is not clear if OLP is the root cause for SCC. It could be something else. Also Homeopath is very famous in OLP and has seen over 4000 cases in the past. He told me it does not appear to be anything that I should get another biopsy based on clinical and present look and feel. There is no need to biopsy every year unless clinical signs warrant that.))) ***Yes it is not 100% fix rule to go for biopsy but as I said it is better to go for yearly biopsy to remain on the safe side. I have reviewed and can see in pictures that you have a much improved lesions now. It is better looking than before. ((( I will see oral surgeon to find out his opinion and see if another biopsy is needed. I may have to pay out of pocket for that. My insurance has changed and it gets harder to do biopsies unless primary care physicians recommends it. I will need referral for oral surgeon since I have HMO. I hate HMO's, and that's why everything I have to go through primary care physician, the cycle gets longer, many times the surgeons I had seen in the past are out of network. It's just big pain to get anything done))) ***Yes I am of the same view. HMO has got some issues that bother a lot of patients and many Physicians don't accept this insurance due to its limitations. But you may call a Surgeon and ask if he is in the network and then get referred to him through your PCP. Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with expert opinion. Please don't forget to give Five Star rating to help me assist my patients in a better way; and, please don't forget to 'Close This Discussion'. For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time). Regards! DR. XXXXXXX HANIF USA