Mucoscopic Features of Oral Lichen Planus: A Retrospective Comparative Study with Inflammatory Mimickers

<b>Background/Objectives</b>: Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disorder with a recognized potential for malignant transformation. While histopathological examination remains the diagnostic gold standard, mucoscopy has emerged as a valuable non-invasive tool for assessing striae patterns, vascular features, and pigmentary alterations. This study aimed to evaluate the mucoscopic characteristics of OLP across different oral mucosal sites and to compare them with other inflammatory oral conditions, assessing their diagnostic relevance. <b>Methods</b>: A retrospective comparative study was conducted on 106 patients, including 33 with histopathologically confirmed OLP and 73 with other inflammatory oral conditions (pemphigus vulgaris, chronic cheilitis, hyperplastic oral candidiasis, leukoplakia, squamous cell carcinoma, pachyonychia congenita, morsicatio buccarum). Mucoscopic evaluation focused on the buccal mucosa, vermilion, and lingual mucosa. Features assessed included background color, white striae patterns, vascular morphology, the presence of erosions, and other features like blunting of the lingual papillae and scales on the vermilion. Statistical analysis was carried out using SPSS 29.0. <b>Results</b>: Reticular striae were highly specific to OLP, particularly on the buccal mucosa (90.9%, <i>p</i> < 0.001). Leukoplakia-like lesions were most prevalent on the lingual mucosa and significantly associated with dotted (<i>p</i> = 0.027) and looped vessels (<i>p</i> = 0.002). Erosions correlated significantly with both dotted (<i>p</i> < 0.001) and linear vessels (<i>p</i> = 0.011), especially in lingual and vermilion lesions. In comparison, control group lesions displayed significantly more globular structures (<i>p</i> < 0.001), veil-like patterns (<i>p</i> < 0.001), and diffuse vascular distributions (<i>p</i> = 0.018), particularly in cheilitis and candidiasis cases. <b>Conclusions</b>: Mucoscopy reveals distinct site-specific patterns in OLP, supporting its role as a non-invasive diagnostic aid. Comparative analysis highlights its utility in differentiating OLP from other inflammatory oral conditions and in identifying lesions with features suggestive of malignant potential. These findings support the integration of mucoscopy into routine clinical practice and warrant further validation through larger, prospective studies.