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A Guide to Clinical Differential Diagnosis of Oral Mucosal Lesions
Table 1. White Surface Lesions of Oral Mucosa

Course Author(s): Michael W. Finkelstein, DDS, MS; Emily Lanzel, DDS, MS; John W. Hellstein, DDS, MS

Table 1. White Surface Lesions of Oral Mucosa

EPITHELIAL THICKENING WHITE LESIONS
Asymptomatic; rough to palpation; fixed to the surface (won’t rub off)
Lichen planus Multiple areas of mucosa involved; bilateral distribution; white plaques arranged in striated pattern associated with erythema; ulcers may be present; skin lesions may be present.
Nicotine (nicotinic) stomatitis Hard palate; mainly in pipe or cigar smokers.
Hairy tongue Dorsum of tongue.
Hairy leukoplakia Lateral surface of tongue; patient is immunocompromised, e.g. AIDS.
White sponge nevus Multiple lesions affecting broad areas of mucosa; familial history; present from early age; genital & rectal mucosa may be affected.
Leukoedema Bilateral on buccal mucosa. Disappears when tissue is stretched.
Erythema migrans (geographic tongue, benign migratory glossitis) Multiple red patches with irregular yellow-white border; dorsal lateral tongue; lesions migrate; usually asymptomatic.
Hyperkeratosis May resolve spontaneously.
Epithelial dysplasia
Carcinoma-in-situ
Superficially invasive squamous cell carcinoma
Persistent; usually asymptomatic; more common as red lesion or mixed red and white lesion.
SURFACE DEBRIS WHITE LESIONS
Pain or burning; rubs off; submucosal erythema
Candidosis History of antibiotic therapy, immunosuppression; xerostomia; nail and/or vaginal lesions may be present
Burn (thermal or chemical) History of burn.
Dried, thick saliva Removed with wet gauze.
SUBEPITHELIAL WHITE LESIONS
Asymptomatic; smooth to palpation; surface is translucent.
Cysts Small cysts of oral mucosa can appear white. Examples are congenital keratotic cyst and lymphoepithelial cyst.
Fordyce granules (ectopic sebaceous glands) Yellow, circumscribed, in clusters; most commonly located on buccal mucosa and upper lip.
Mucosal scarring History of injury or surgery; usually poorly defined.