Oral Lesions

Macule

A flat area of altered color, no elevation or depression. (e.g. ephelides, petechiae)

Plaque

A slightly raised, broad, flat-topped lesion, (e,g, oral leukoplakia, psoriasis)

Pustule

A pus-filled lesion, containing yellow pus. (e.g. pimple, PAP)

Sessile lesion

Broad base, with base wider than the top.

Pedunculated lesion

Narrow stalk, base smaller than the top.

Vesicle

A fluid-filled blister less than 5mm, containing serum or mucin. (e.g HSV blister, chickenpox blister)

Bulla

A fluid filled blister greater than 5mm, containing serum or mucin. (e.g. 2nd degree burn blister)

Papule

A small, solid, raised lesion less than 5mm, made of tissue. (e.g. nevus, fordyce granules)

Nodule

A solid, raised lesion greater than 5mm, made of tissue. (e.g. fibroma, lipoma, cyst)

Fordyce granules

Clusters of ectopic sebaceous (oil) glands.

Lingual varicosity

Enlarged, dilated veins on the underside and sides of the tongue; caused by age-related loss of elasticity in venous walls.

Linea alba

A white line on the buccal mucosa at the level where the upper and lower teeth meet; caused by frictional irritation from habits like cheek biting, bruxism, or pressure from teeth.

Leukoedema

A generalized opalescent or milky-white appearance of the buccal mucosa, caused by intracellular edema in the spinous cell layer, making the mucosa appear gray or milky.

• Disappears when tissue is stretched. Considered normal, not malignant.

Lingual thyroid nodule

Ectopic thyroid tissue results from incomplete migration of the thyroid during embryonic development.

• Location: Midline of the dorsal tongue, near the foramen cecum.

Oral squamous papilloma

Benign tumor of squamous epithelium, related to HPV types 6 and 11.

• Small mass with a finger-like appearance. May appear white if keratinized or pink if non-keratinized.

Irritation fibroma

A benign fibrous overgrowth caused by chronic irritation (e.g. cheek biting, friction from sharp teeth).

• Mostly found on buccal mucosa

• Small, firm, smooth, light pink elevated nodule

Neurofibroma

Benign tumors derived from nerve tissue, involve multiple cell types, and are diffuse.

• Slow-growing, soft, painless nodules. Cafe au lait spots (flat, light brown skin patches on the skin)

Squamous cell carcinoma

The most common primary malignancy of the oral cavity, arising from squamous epithelium.

• Risk factors: tobacco use, sun exposure

• Commonly found: ventrolateral tongue, floor of mouth

Basal cell carcinoma

Malignant tumor of basal cells in the deepest layer of the epidermis.

• Present on sun-exposed skin (e.g. face, scalp, ears)

Melanoma

Malignant tumor of melanocytes.

• Most common: skin. (palate, gingiva = rare)

• Dark lesion with irregular borders

Sarcoma

Malignant tumors of CT origin, including bone, muscle, and blood vessels.

Osteosarcoma

A malignant bone tumor, often presenting as painful swelling, tooth mobility, or toothache.

• Radiograph: “sunburst” radiopaque pattern due to spiculated bone formation.

• Common in young adults, affects posterior mandible

Kaposi Sarcoma

A vascular malignancy associated with HHV-8 (herpes), mostly in immunocompromised patients (e.g. HIV/AIDS)

• Red, purple, or bluish plaques or nodules on the palate or gingiva

Leukoplakia

A white patch/plaque on the oral mucosa that cannot be rubbed off and cannot be clinically or histologically diagnosed as any other disease

• White, well-defined plaque; does not wipe off.

Erythroplakia

A red patch on the oral mucosa that cannot be attributed to any other condition.

• Higher risk of malignant transformation than leukoplakia.

Solar Cheilitis (actinic cheilitis)

Precancerous condition caused by chronic sun exposure, especially in fair-skinned individuals.

• Affects lower lip and vermilion border