Diagnosis and treatment for Breakthrough Clinical oral pathology case: No. 28

Stacey L. Simmons, DDS, editorial director of Breakthrough Clinical, gives her differentials for the white, corrugated, irregular-bordered 9x6 mm lesion she discovered last month during the clinical exam of an otherwise-healthy patient. She shares more details and her impressions of the lesion as this oral pathology case unfolds.

Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.

LAST MONTH, I presented the oral pathology case of a healthy 66-year-old female who presented for her recare exam. The patient's health history was noncontributory except for a hip replacement in the last year.

Clinical examination revealed a white, corrugated, irregular-bordered lesion on the attached tissue on the upper right side between teeth Nos. 5 and 6. The lesion measured approximately 9x6 mm. The patient was unaware of the presence of the lesion. The lesion was not tender to touch or palpation, and it was not able to be removed or scraped off.

The patient presented two weeks later after the initial discovery of the upper right vestibular lesion. For the most part, the lesion had not changed, except that it had extended back toward the first molar to the mucolabial fold area. The patient was referred to the oral surgeon for assessment and biopsy.

Impressions of the lesion

No real clear etiology. The patient presented with a clean health history.
The dysplastic nature of the lesion, with it presenting as a large leukoplakic patch over erythematous tissue, does give rise to concern and is overall more worrisome. Lack of pain and tenderness does not negate its potential severity.
Differentials include: lichen planus, carcinoma (in situ), and benign hyperkeratosis.
A biopsy was scheduled for a definitive diagnosis.

Regrettably, due to scheduling conflicts and the timing of this writing, the patient has not yet had a biopsy but will within the week. A definitive report for this case will be given in next month’s pathology presentation in Breakthrough Clinical.

Reference guide for leukoplakic lesions

A short background on leukoplakic lesions (from a previous pathology case) can be found at this link as a reference and general guide to follow.

Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.

For more pathology cases, click here.

Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, DE’s Breakthrough Clinical with Stacey Simmons, DDS, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at [email protected].