Cell-mediated mucositis of the oral cavity: narrative review on etiology, clinico-pathological aspects and malignant transformation

Cell-mediated mucositis is the expression of a type IV hypersensitivity, in which cytotoxic CD8+ T lymphocytes attack the keratinocytes of the basal layer responsible for activating the immune response. There is sufficient evidence for an increased risk of oral cancer in patients with a diagnosis cell mediated mucositis. This review aims to examine the etiology, clinical-histological features, management and malignant transformation of a group of cell-mediated mucositis, including oral lichen planus, oral lichenoid lesions, Graft versus host disease, oral lesion of lupus erythematous. The authors conducted a literature review, selecting relevant studies based on their novelty, applicability, and impact. The text highlights the varying rates of malignant transformation associated with different oral conditions. For oral lichen planus, the risk of transformation ranges from 0.44% to 2.28%, while for oral lichenoid lesions (OLLs), the rate is slightly higher, between 1.20% and 3.80%. Conditions like graft-versus-host disease are linked to a malignant transformation rate of 3.47%, and oral lesions associated with lupus erythematosus carry a similar risk at 3.3%, often involving squamous cell carcinoma of the lips. In cases of oral epithelial dysplasia, the risk increases significantly with severity, reaching 24.1% for severe dysplasia. The condition with the highest malignant potential is proliferative verrucous leukoplakia, with a transformation rate estimated at 49.5%. These findings underscore the importance of accurate diagnosis, vigilant monitoring, and the development of new therapeutic strategies. Recent advancements in treatments, such as nivolumab and imiquimod, show promise in early trials. These approaches aim to move beyond passive observation, shifting towards personalized medical interventions to reduce the risk of malignant transformation in high-risk patients.