Lichenoid granulomatous reaction is a very rare and controversial entity, microscopically characterized by the presence of histiocytes and granulomatous infiltrate together with a justaepithelial band-like lymphocytic process. It may be under-reported and frequently misdiagnosed by pathologists not familiarized with this condition. Depending on the anatomical location affected by this disorder, it can be named as lichenoid granulomatous dermatitis when the skin is primarily affected, or lichenoid granulomatous stomatitis when the oral mucosa is the affected tissue. The etiology and pathogenesis of this condition are largely unknown, but different authors claim that it can be associated with medications, microorganisms, and foreign materials. In the oral cavity, lichenoid granulomatous stomatitis more often presents as erythematous patches or swellings in the upper lip mucosa, predominantly affecting adult females with a mean age of 59 years. Affected patients are usually treated with steroids, but the lesions can be persistent and refractory to treatment.