This systematic review and meta-analysis updates the evidence on the potential for malignancy in oral lichen planus (OLP) and related conditions. The study included 101 primary-level studies (38,083 patients) published between November 2018 and November 2023, focusing on the malignant transformation ratio of OLP and related lesions. The pooled malignant transformation ratio for OLP was 1.43% (95% CI = 1.09–1.80), for oral lichenoid lesions (OLLs) was 1.38% (95% CI = 0.16–3.38), for lichenoid reactions (LRs) was 1.20% (95% CI = 0.00–4.25), and for OLP with dysplasia was 5.13% (95% CI = 1.90–9.43). No significant differences were found between OLL or LR groups and the OLP subgroup, but the malignant transformation was significantly higher for the OLP with dysplasia group. Factors significantly associated with an increased risk of malignancy included epithelial dysplasia, higher methodological quality, tobacco and alcohol consumption, tongue location of lesions, atrophic and erosive lesions, and hepatitis C virus (HCV) infection. The study concludes that OLP is an oral potentially malignant disorder (OPMD) with a potentially underestimated malignancy rate due to inadequate diagnostic criteria and low methodological quality. Clinicians should be aware of the importance of performing biopsies and follow-up for OLP patients, and future studies should adhere to high methodological standards.This systematic review and meta-analysis updates the evidence on the potential for malignancy in oral lichen planus (OLP) and related conditions. The study included 101 primary-level studies (38,083 patients) published between November 2018 and November 2023, focusing on the malignant transformation ratio of OLP and related lesions. The pooled malignant transformation ratio for OLP was 1.43% (95% CI = 1.09–1.80), for oral lichenoid lesions (OLLs) was 1.38% (95% CI = 0.16–3.38), for lichenoid reactions (LRs) was 1.20% (95% CI = 0.00–4.25), and for OLP with dysplasia was 5.13% (95% CI = 1.90–9.43). No significant differences were found between OLL or LR groups and the OLP subgroup, but the malignant transformation was significantly higher for the OLP with dysplasia group. Factors significantly associated with an increased risk of malignancy included epithelial dysplasia, higher methodological quality, tobacco and alcohol consumption, tongue location of lesions, atrophic and erosive lesions, and hepatitis C virus (HCV) infection. The study concludes that OLP is an oral potentially malignant disorder (OPMD) with a potentially underestimated malignancy rate due to inadequate diagnostic criteria and low methodological quality. Clinicians should be aware of the importance of performing biopsies and follow-up for OLP patients, and future studies should adhere to high methodological standards.