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Oral Pathology:  Soft Tissue Case #6

 

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Patient: Elderly adult, either sex

Chief Complaint:
Patient requests a routine examination.

Medical History:
The patient had a stroke three years ago and takes Inderal for congestive heart failure. The patient has occasional dyspnea, uses extra pillows when sleeping, and reports edema of the ankles. The patient has smoked five cigarettes per day since high school.

Dental History:
The patient has had infrequent dental care. The patient has been edentulous for fifteen to twenty years, has had the current dentures for fifteen years, and wears the dentures 24 hours a day.

Clinical Findings:
A diffuse white lesion involves the anterior floor of the mouth. The lesion is flat, nontender, fixed to the surface mucosa but not to the underlying structures. The white areas are rough to palpation and will not rub off. The lesion is asymptomatic. The patient was unaware of the lesion.

Clinical Images
white lesion in the floor of the mouth closer view of lesion
White Lesion in the Floor of the Mouth Closer View of 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:
This is a white surface lesion.  It is white due to epithelial thickening because it is rough, asymptomatic, and will not rub off.

Lesions to Exclude from Differential Diagonsis:
Leukoedema
  ~Location – Bilateral buccal mucosa
Lichen Planus
  ~Bilateral
  ~Multifocal
Nicotinic Stomatitis
  ~Location – Hard Palate
Familial Epithelial Hyperplasia (White Sponge Nevus)
  ~Diffuse and multifocal
  ~Present from early childhood
  ~May have a familial history
Hairy Tongue, Geographic Tongue (Erythema Migrans), and Hairy Leukoplakia
  ~Location – Tongue

Lesions to Include in Differential Diagnosis:
Hyperkeratosis
Epithelial Dysplasia
Carcinoma-in-situ
Squamous Cell Carcinoma

Management:
Excisional Biopsy
  ~Lesion is small
  ~In an area which is high risk for squamous cell carcinoma
Patient Education
  ~Explain the difference in significance of the lesions in differential diagnosis
  ~Explain health risks of SCC
  ~Explain the prognosis of excisional biopsy vs. no treatment
  ~Explain the risks of continued smoking
  ~Tell the patient how you can help them if they are interested in quitting smoking

Final Diagnosis:
Carcinoma-in-situ