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Oral Pathology:  Soft Tissue Case #31

 

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Patient: Young child of either sex.

Chief Complaint:
The patient complains of a soft tissue enlargement at the corner of the mouth. The lesion has been present three months and is slowly increasing in size.

Medical History:
No abnormalities are identified.

Dental History:
No abnormalities are identified.

Clinical Findings:
The lesion is an exophytic, broad-based, well-circumscribed papule, approximately 3 mm in diameter, located at the left angle of the mouth. The lesion is firm, rough, nontender and fixed to surface mucosa, but not to underlying structures.

Clinical Images
left angle of the mouth showing lesion close-up of left angle of mouth and lesion
Left Angle of the Mouth Showing Lesion Close-up of Left Angle of Mouth and Lesion

 

There are no radiographs available for this case.

There are no lab reports available for this case.

There are no charts available for this case.

Summary:
The patient complains of a firm, exophytic, broad-based, non-tender, well-circumscribed, 3 mm in diameter, soft tissue enlargement at the left corner of the mouth. The lesion is of 3 months duration and is slowly growing in size.  The lesion has a rough surface and is fixed to the surface mucosa, but not to underlying structures.

Lesions to Exclude from Differential Diagnosis:
This lesion is described as an exophytic soft tissue enlargement.  Reactive soft tissue enlargements can be excluded because the lesion is persistant, progressive, asymptomatic, and it is not growing at a very rapid rate.

Within the category of tumors, malignant tumors and soft tissue cysts may be excluded.  Malignant tumors are excluded because these are fixed to surrounding structures and they are not pedunculated nor are they well-circumscribed.  Soft tissue cysts may also be eliminated because they do not have a rough surface, they are compressible and they are not pedunculated.

Benign tumors is the only category remaining and they are often characterized by their slow growth rate (months to years) and also as being asymptomatic and freely movable (not attached to surrounding structures)—all of which describe the present case.  Within the category of benign tumors, salivary gland and mesenchymal tumors can be eliminated because these do not have a rough overlying surface.

Benign epithelial tumors include papilloma, verruca vulgaris, and condyloma acumintum.  Condyloma acuminatum can be excluded because these are not pedunculated and are typically multiple.

Lesions to Include in the Differential Diagnosis:
Thus, the differential diagnosis includes papilloma and verruca vulgaris.  Squamous papilloma is typically pedunculated, while verruca vulgaris has a broad base, which is more consistent with the lesion in this case.

Management:
Treatment of oral verruca vulgaris is excisional biopsy, which will provide both a microscopic diagnosis and a cure.  The patient should be informed of the nature of the lesion (human papilloma virus infection), reason for excision (if not excised, it can be transmitted to other skin and mucosal surfaces in the same patient or to other persons), and that recurrence occasionally occurs.  Prognosis is good.

Final Diagnosis:
Verruca Vulgaris