RED AND WHITE LESIONS OFTHE ORAL MUCOSA

HEREDITARY WHITE LESIONS REACTIVE/INFLAMMATORY WHITE LESIONS INFECTIOUS WHITE LESIONS AND WHITE AND RED LESIONS IDIOPATHIC “TRUE” LEUKOPLAKIA BOWEN’S DISEASE ERYTHROPLAKIA ORAL LICHEN PLANUS LICHENOID REACTIONS LUPUS ERYTHEMATOSUS (SYSTEMIC AND DISCOID) DEVELOPMENTAL WHITE LESIONS: ECTOPIC LYMPHOID

TISSUE FORDYCE’S GRANULES GINGIVAL AND PALATAL CYSTS OF

THE NEWBORN AND ADULT MISCELLANEOUS LESIONS

LEUKOEDEMA

Etiology Unknown Benign; common in general

population, with racial clustering in Blacks

Clinical Presentation Symmetric, asymptomatic. Buccal mucosa involved by gray-

white, diffuse, milky surface with an opalescent quality.

Wrinkled surface features at rest. Dissipation of changes with

stretching of mucosa.

Diagnosis Clinical recognition is sufficient. Biopsy findings will show marked

intracellular edema of spinous layer. Individual cells with clear cytoplasm and

compact nuclei. Normal basal cell layer.

Differential Diagnosis Cheek chewing Hereditary benign intraepithelial

dyskeratosis White sponge nevus Lichen planus Candidiasis

Treatment None necessary; no relation to

dysplasia /carcinoma Reassurance

Prognosis Excellent

WHITE SPONGE NEVUS

Etiology Hereditary (autosomal-dominant)

disorder of keratinization affecting nonkeratinizing oral, esophageal, and anogenital mucosal epithelium.

Point mutations in the keratin 4 and/or 13 genes

Clinical Presentation Asymptomatic Deeply folded, thickened, white mucosa Buccal mucosa chiefly affected No functional impairment Increased prominence during second

decade

Microscopic Findings Parakeratosis, acanthosis, intracellular

edema Perinuclear condensation of keratin

Diagnosis Clinical appearance Family history Microscopic findings

Differential Diagnosis Idiopathic leukoplakia Chemical/thermal burn Chronic low-grade trauma (morsicatio)

Treatment None required No malignant potential

Prognosis Excellent

HEREDITARY BENIGN INTRAEPITHELIAL DYSKERATOSIS

Etiology It is a rare, autosomal dominant

hereditary condition. Also known as Witkop’s disease.

Clinical Presentation Early onset of bulbar conjunctivitis and oral white

lesions. Preceding the bulbar conjunctivitis are foamy

gelatinous plaques that represent the ocular counterpart of the oral mucosal lesions.

Oral lesions consist of soft, asymptomatic, white folds and plaques of spongy mucosa.

Areas characteristically involved include the buccal and labial mucosa and labial commissures, as well as the floor of the mouth and lateral surfaces of the tongue, gingiva, and palate. The dorsum of the tongue is usually spared.

Patients may complain of photophobia, especially in early life. Blindness, secondary to corneal vascularization, has been reported.

Diagnosis Clinical appearance Family history Microscopic findingsDifferential Diagnosis Idiopathic leukoplakia Chemical/thermal burn Chronic low-grade trauma (morsicatio) Lichen planus Lubus erythematosus

Treatment None required For evaluation and treatment of

the ocular lesions, the patient should be referred to an ophthalmologist.

Prognosis Excellent