Diagnosis and treatment for Breakthrough Clinical oral pathology case: No. 25

Breakthrough Clinical's Editorial Director Dr. Stacey Simmons gives her diagnosis for the oral pathology case of a 77-year-old male who presented with a 6 mm x 8 mm white leukoplakic lesion on the left lateral border of the tongue. She also outlines diagnostic assessments to consider should you encounter similar lesions in the future.

May 2nd, 2017
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Dr. Stacey Simmons gives her diagnosis for the case of a 77-year-old male who presented with a 6 mm x 8 mm white leukoplakic lesion on the left lateral border of the tongue. She also outlines diagnostic assessments to consider should you encounter similar lesions in the future.


This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

Last month, I described the case of a 77-year-old male who presented for his annual checkup and exam. He visits our office only once a year and alternates with his dentist in California the other six months, where he is a snowbird during the winter. The patient's health history was noncontributory except for blood pressure medication.

The patient's chief complaint was a white spot on the left side of his tongue that had been present for just less than a year. Clinical assessment revealed a 6 mm x 8 mm white leukoplakic lesion on the left lateral border of the tongue. The lesion was not painful to palpation or touch, and it was slightly corrugated with irregular borders.

Differential diagnoses

  • Squamous cell carcinoma
  • Acute glossitis with squamous hyperplasia
  • Localized lichen planus

Definitive diagnosis: Acute glossitis with superficial erosions superimposed on pseudoepitheliomatous squamous hyperplasia with mild atypia

The unknown etiology of the lesion automatically put it into a category that made it a high-risk leukoplakia, especially since it had been present for just under a year. The patient was referred to an oral surgeon for excisional biopsy. The final diagnosis, as given above, did not reveal any evidence of malignancy. Because the findings were consistent with inflammatory changes, it was recommended that the patient be monitored for any future premalignant changes or tendencies. A three-month follow-up has been recommended.

A previous leukoplakic pathology case was presented last year. The following is taken from that post and gives a general background on leukoplakic lesions and is a good reference to follow. Click here for a link to that particular case.

“The presence of leukoplakic lesions in the oral cavity are always cause for evaluation and follow-up. The World Health Organization defined leukoplakia as “a white patch or plaque that cannot be characterized clinically or pathologically as any other disease.” (1) Leukoplakic lesions are one of the more common forms of epithelial dysplasia, typically discovered during routine exams; they are usually asymptomatic and represent 6.2% of all oral biopsy specimens. (1) Leukoplakia and squamous cell carcinoma (SCC) share many of the same etiology factors (1), and approximately 5.4% of leukoplakic lesions become SCC (2). It is, therefore, imperative that the following be considered: (1)

  1. Assess etiologic factors (table 1)
  2. Categorize the lesion as a high- or low-risk specimen (table 2)
  3. Assess differentials (table 3)
  4. If warranted, biopsy lesion for a definitive diagnosis

This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.


For more pathology cases, click here.


References

1. Wood NK, Goaz PW. Differential Diagnosis of Oral and Maxillofacial Lesions. 5th ed. Maryland Heights, MO: Mosby Publishing; 1997:75-77, 98-103, 106-107.

2. Sapp JP, Eversole LR, Wysocki GP. Contemporary Oral and Maxillofacial Pathology. St. Louis: MO: Mosby; 1997


For more articles about clinical dentistry, 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 ssimmonsdds@gmail.com.


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