Objective  To investigate the clinical, endoscopic, and histopathological features of patients with early esophageal cancer and precancerous lesions having white lichenoid lesions.

  Methods  The data from patients who underwent endoscopic submucosal dissection (ESD) between September 2017 and August 2021, and from patients who were pathologically diagnosed with early esophageal cancer and precancerous lesions after surgery were retrospectively collected. A total of 198 patients were included in the study to determine whether they had white lichenoid lesions by endoscopy. The patients were assigned into two groups and were analyzed based on their differences in clinical, endoscopic, and histopathological characteristics.

  Results  Of the 198 patients with early esophageal cancer and precancerous lesions, 119 had white lichenoid lesions. The lesions were significantly associated with positive margins after ESD (P=0.032). Thirty-four specimens had positive margins after ESD. Multivariate analysis revealed that the combination of white lichenoid lesions (P=0.036), cumulative peritubular extent of lesions (>3/4 peritubular area, P<0.001), postoperative pathology (below intramucosal cancer, P=0.002), and depth of lesion invasion (below M3, P<0.001) were independent risk factors for positive margins after ESD.

  Conclusions  Patients with early esophageal cancer and precancerous lesions having white lichenoid lesions were at an increased risk of positive margins after ESD. In addition, the cumulative peritubular range of lesions >3/4 peritubular area and the depth of lesion invasion were independent risk factors for positive margins.