A Guide to Clinical Differential Diagnosis of Oral Mucosal Lesions

A 19-year-old woman has painful ulcers on the labial mucosa and buccal mucosa of 4 days duration. She has had similar ulcers on previous occasions, and each time the lesions healed in approximately 7 days. The best diagnosis is

aphthous ulcers

A 67-year-old woman has a chronic sore mouth of 2 years duration. The lesions consist of multiple persistent ulcers adjacent to white rough thickened areas which do not rub off and are arranged in a striated pattern. The lesions are bilateral and involve the buccal mucosa, lateral borders of the tongue, and gingiva. Of the following, the best diagnosis is

lichen planus

A patient has multiple, asymptomatic, irregular, flat patches on the dorsum of the tongue. Each patch has a red center and an irregular white periphery. The patient reports that the lesions come and go. The best diagnosis is

geographic tongue (erythema migrans)

A 16-year-old woman has a compressible, nontender, 5x5 mm soft tissue enlargement of the lower labial mucosa. The lesion has a blue mucosal surface which does not blanch upon palpation. The patient states that she has been aware of the lesion for 2 months and that it has increased and decreased in size during this time. Of the following, the best diagnosis is

mucocele

A 13-year-old female patient has mild fever, lymphadenopathy and vesicles and ulcers of the soft palate and tonsillar pillars bilaterally, of 5 days duration. No other oral lesions are present. The best diagnosis is

herpangina

A patient has a white, nontender, 5 x 6 mm, soft tissue enlargement on the right soft palate of at least 2 years duration. The surface is rough and resembles a wart. The lesion is pedunculated. The best diagnosis is

papilloma

A 44-year-old man has rough, white, nonpainful lesions which do not rub off located bilaterally on the buccal mucosa, floor of the mouth, and hard and soft palates. He states that he has been aware of the lesions since childhood. Of the following, the best diagnosis is

white sponge nevus

A 25-year-old woman has a 5x6 mm, nontender, compressible soft tissue enlargement located on the interdental papilla between teeth #10 and #11. The lesion is erythematous and bleeds easily. She states that she has been aware of the lesion for approximately 3 days. The patient is in her second trimester of pregnancy. Of the following, the best diagnosis is

pyogenic granuloma

Which white surface lesion rubs off?

Burn

Which of the following lesions is asymptomatic and smooth to palpation?

Scarring

Which pigmented surface lesion is consistently flat and not thickened?

Oral melanotic macule

Which one of these clinical features would be most helpful in distinguishing hematoma from nevus?

Duration of the lesion

A patient has a thickened, compressible, blue pigmentation of the buccal mucosa that blanches upon pressure. Which of the following should be included in the clinical differential diagnosis?

Varix

Which of the following diseases initially forms oral vesicles?

Mucous membrane (cicatricial) pemphigoid

Which of the following lesions have/has an abrupt or sudden onset?

Recurrent herpes

Which disease has the worst prognosis?

Pemphigus vulgaris

A 35-year-old man has painful ulcers on the lips and buccal mucosal and asymptomatic macules and vesicles on the face, hands, and trunk. He has a mild fever but no lymphadenopathy. The lesions had an acute onset 3 days ago. The best diagnosis is

erythema multiforme

Which disease typically begins with the abrupt onset of pain or altered sensation followed by vesicles and ulcers unilaterally in the distribution of a peripheral nerve?

Herpes zoster

Which of the following lesions is usually congenital?

Hemangioma

Which of the following lesions is/are encapsulated?

Schwannoma

Which of the following lesions is/are compressible to palpation?

Low-grade mucoepidermoid carcinoma