Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Oral Stomatitis Mimicking Lichenoid Lesions Following Pembrolizumab Therapy

  • Hee-Won Kim (Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital) ;
  • Yong-Woo Ahn (Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital) ;
  • Sung-Hee Jeong (Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital) ;
  • Soo-Min Ok (Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital) ;
  • Hye-Min Ju (Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital)
  • Received : 2025.05.30
  • Accepted : 2025.06.09
  • Published : 2025.06.30
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Abstract

Immune checkpoint inhibitors (ICIs), particularly pembrolizumab, have revolutionized cancer treatment by improving survival in patients with advanced malignancies. However, these agents are also associated with immune-related adverse events (irAEs), including manifestations in the oral cavity. Among them, oral lichenoid lesions (OLL) are rare and frequently underdiagnosed, partly due to their clinical similarity to oral lichen planus and their often-non-specific histopathologic features. We describe the case of a 64-year-old male patient with stage IVB squamous cell carcinoma of the lung who developed painful erosive and reticular lesions on the tongue, buccal mucosa, and palate after 12 cycles of pembrolizumab. Histological analysis showed chronic inflammatory infiltrates without definitive diagnostic features. Based on the clinical presentation and temporal correlation with pembrolizumab therapy, a provisional diagnosis of ICI-induced OLL was made. The patient was managed with high-potency topical corticosteroids, including clobetasol propionate and desoximetasone, as well as corticosteroid gargles. This approach led to significant symptom relief and lesion resolution without the need for systemic immunosuppression or interruption of immunotherapy. Regular clinical follow-up and laboratory monitoring were implemented due to the prolonged use of topical corticosteroids and the recognized risk of malignant transformation in OLL. This case highlights the importance of early recognition and accurate diagnosis of oral irAEs during ICI therapy. It also emphasizes that conservative topical management can be effective in maintaining oncologic treatment while ensuring patient comfort and safety.

Keywords

Acknowledgement

This study was supported by Clinical Research Grant, Pusan National University Dental Hospital (2024).

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