Background: Oral lichen planus is an immune mediated mucosal disorder affecting up to 2% of the population. Dysplasia has been known to develop in 0.1% to 1% of patients with lichen planus. This necessitates close surveillance for the development of atypical lesions.

Case: Described is the case of a 68-year-old female patient with oral lichen planus who developed a non-healing ulceration on her right lateral tongue. Out of concern for neoplasia, a biopsy was performed. Histopathologic report indicated features consistent with traumatic ulcerative granuloma. The lesion did not return.

Conclusions: Oral lichen planus is a common mucosal disease. Although uncommon, traumatic ulcerative granuloma should be considered when atypical ulcerations arise in patients with lichen planus. However, such atypical ulcerations cannot be assumed to be benign. Prompt biopsy is appropriate due to the risk for dysplasia associated with lichen planus.