62 Oral Lesions
62.1 Oral Ulcers
Oral ulceration is the most common complaint presenting to both primary and specialist care and the aetiology includes a wide variety of both trivial and serious conditions. Management is informed by careful history and examination and selective use of biopsy where indicated. The four commonest causes of oral ulceration are trauma, aphthae, oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC) (Table 62.1).
62.2 Oral Squamous Cell Carcinoma
The majority of ulcers are painful, with the notable exception of OSCC, which is often painless. The lesion presents as a rolled everted margin with a sloughy base (Fig. 62.1). A persistent, painless ulcer found on routine examination, particularly in the elderly and in those who drink and smoke, should be considered an SCC.
Primary (lesions start as an ulcer)
Oral squamous cell carcinoma (OSCC), minor salivary gland malignancies
Recurrent apthous stomatitis
Minor, major and herpetiform. May be associated with Fe/B12 deficiency, with GI conditions (Crohn’s, UC) or other conditions
Usually dental in origin
TB, syphilis and HIV
Aspirin and other caustic burns, cytotoxic drugs
Secondary (bullous lesions that break down to cause an ulcer)
Pemphigus, pemphigoid and epidermolysis bullosa
Angina bullosa haemorrhagica
Abbreviations: GI, gastrointestinal; TB, tuberculosis; UC, ulcerative colitis.
62.3 Oral Lichen Planus
OLP is a common, often asymptomatic disease that may present with lesions which are typically reticular. It is common in middle-aged women (Fig. 62.2). Specifically, erosive, atrophic and bullous forms are painful and may present with oral ulceration. The cause is unknown and symptomatic treatment is usually reliant on topical or systemic steroids. Additionally, there is a small risk of malignant transformation, which is higher in conditions where OLP coexists with dysplastic change and other atypical lesions. OLP can coexist with extraoral lesions on genitalia, oesophagus, wrists or ankles. Lichenoid reactions may be local or systemic and bear some of the clinical and/or pathological characteristics of OLP.