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Objectives: To investigate the role of oral lichen planus (OLP) on the long‐term prognosis of oral epithelial dysplasia (OED). Methods: Retrospective single‐centre cohort study using the 2007–2019 database of the Head and Neck Cancer and Oral Medicine units of University College London Hospital. The exposure of interest was the presence of OLP, and the prognostic outcomes included the development of new primary episodes of OED, progression to malignancy and mortality. Cox proportional hazard and Poisson regression models were performed. Results: A total of 299 patients, of whom 144 had OED arising on the background of OLP (OLP/OED) and 155 had OED without underlying OLP (non‐OLP/OED), were included. A pre‐existing diagnosis of OLP was significantly associated with a twofold increased risk of subsequent primary OED events (HR = 2.02, p = 0.04), which also developed faster (1.46 vs. 2.96 years, p = 0.04) and with more involvement of non‐cancer‐prone sites (p = 0.001) than in the non‐OLP/OED group. There was no difference between groups in the progression to malignancy or mortality. Conclusions: Oral lichen planus/OED patients are at higher risk of multiple episodes of primary OED, which can develop faster and at non‐cancer‐prone sites as compared to non‐OLP/OED individuals. Further research is needed to clarify the effects of OLP upon progression to OSCC and mortality. [ABSTRACT FROM AUTHOR]