Oral Lesions

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) (imageTable 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 (imageFig. 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.

image Table 62.1 Causes of oral ulceration

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
Drugs causing neutropenia, nicorandil and lichenoid reactions

Secondary (bullous lesions that break down to cause an ulcer)


Herpetic gingivostomatits


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 (imageFig. 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.

Mar 31, 2020 | Posted by in OPHTHALMOLOGY | Comments Off on Oral Lesions

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