Quartz 4

3. Soft Tissue Examination

17 min read

# Introduction to Clinical Dentistry: Soft Tissue Examination

Lecture Outline

  • A brief review of oral anatomy
  • Develop a systematic approach to examining the soft tissues of the oral cavity
  • Learn descriptive terminology for describing oral lesions
  • Identify the characteristic features of lesions that suggest serious pathology
  • Be able to recognize some common oral lesions

# Brief Review of Oral Anatomy

Temporomandibular Joint (Lateral Pole)

Muscles of Mastication

  • Temporalis muscle: A broad, fan-shaped muscle involved in jaw movement.
  • Masseter muscle: A major muscle responsible for chewing by enabling jaw elevation.

Salivary Glands

  • Parotid glands
  • Submandibular glands
  • Sublingual glands

Lymph Nodes

Lips – Vermilion Border

Labial Mucosa

  • Lower labial mucosa
  • Upper labial mucosa

Gingiva and Buccal Mucosa

  • Gingiva
  • Right buccal mucosa
  • Stenson’s duct opening

Tongue

  • Dorsal tongue
  • Lateral surface of tongue
  • Lingual tonsils

Ventral Tongue and Floor of Mouth

  • Ventral surface of tongue
  • Floor of mouth
  • Wharton’s duct opening
  • Lingual frenum

Hard Palate

  • Hard palate
  • Torus palatinus

Oropharynx

  • Oropharynx
  • Uvula
  • Tonsillar pillars
  • Base of tongue

A Systematic Approach to Examining the Soft Tissues of the Oral Cavity

Clinical History

Before Every Clinical Examination Should Be a Thorough Clinical History!

Systematic Examination Guidelines

  • Use the same system every time to ensure you don’t miss out any anatomical structures.
  • Start with extra oral examination followed by intra oral exam.
  • Palpation of the oral tissues is key.
  • Equipment: Intra oral mirrors (2), gauze, ruler, adequate light source (ideally LED white headlight affixed to loupes to keep both hands free).
  • Try standing in front of the patient for the soft tissue exam.

Extra Oral Examination

General Inspection:

  • Facial Symmetry
  • Profile Type
  • Cutaneous skin on face and scalp
  • TMJ and masticatory muscles
  • Lymph nodes
  • Salivary glands
  • Lips

TMJ and Muscles of Mastication

Bimanual Palpation

  • Note any clicks, crepitus, restricted mouth opening, pain on palpation.

Lymph Nodes Examination

  • Level I nodes: submandibular and submental triangles

  • 1 cm size suspicious of lymphadenopathy

Anterior and Posterior Triangles of the Neck

  • Level II, III, IV lymph nodes detected within the anterior and posterior triangle of the neck
  • Use the sternocleidomastoid muscle as landmark!

Lips Examination

  • Sharply demarcated
  • Homogenous in colour and texture
  • Bimanual palpation for surface changes
  • Note any colour irregularities or surface changes

Intra Oral Examination

Buccal Gingiva and Mucosa

  • Maxillary and mandibular buccal gingiva
  • Bilateral buccal mucosa
  • Remember to palpate the vestibules!
  • Palpate parotid gland extra orally to excrete saliva and evaluate Stenson’s duct patency

Tongue Examination

  • Dorsal tongue → bilateral lateral tongue
  • Remember posterior lateral tongue, and lingual tonsils!

Ventral Tongue and Floor of Mouth Examination

  • Ventral tongue → Floor of mouth → Mandibular lingual gingiva
  • Dry floor of mouth with gauze, evaluate saliva excretion from Wharton’s duct
  • Palpate (“Milk”) submandibular glands extra orally to secrete saliva
  • Note the presence, consistency/viscosity of saliva
  • Bimanual palpation of floor of mouth for any subtle submucosal swellings

Hard Palate and Oropharynx Examination

  • Hard palate
  • Palatal gingiva
  • Palpate for submucosal swellings
  • Use tongue blade or mouth mirror to depress tongue to evaluate oropharynx
  • Evaluate from front of patient – not behind!
  • Say “Ahh” to evaluate elevation of soft palate
  • Evaluation of base of tongue

Putting it Together: Intra Oral Examination

Labeled Sections:

  • A: Closed lips – examining external appearance.
  • B: Open mouth – assessing general dentition and occlusion.
  • C: Retraction of the lips – examining the mucosa inside the mouth.
  • D: View of the maxillary palate.
  • E: View of the upper teeth and gums.
  • F: Inspection of the posterior molars and oral cavity using a mouth mirror.
  • G: Tongue protrusion – examination for symmetry and lesions.
  • H: Use of gloves to retract the tongue for lateral examination.
  • I: Examination of the underside of the tongue.
  • J: Inspection of the ventral surface of the tongue.
  • K: Full dentition view from an inferior perspective.
  • L: Lateral tongue examination by moving it aside.
  • M: Oropharyngeal inspection – assessing tonsils and throat.
  • N: Examining the buccal cavity using a retractor.
  • O: Using gauze to manipulate the tongue to check lateral borders.
  • P: Use of a dental instrument to check tooth surfaces.

Finish with Clinical Photograph!

Learn Descriptive Terminology for Describing Oral Lesions

Refer with “CLOTHS”

Description
ColourRed; White; Speckled; Pigmented
LocationLesion in relation to anatomical sites
OutlineWell demarcated; Diffuse
TextureUlcerated; Indurated; Granular; Smooth; Flat; Raised; Hard; Soft; Verrucous
HistoryOnset; Duration; Symptoms; Any changes
SizeLength; Width; Depth (mm)
Patel, J., Tyers, C. & Sandhu, P. Refer with CLOTHS. Br Dent J 228, 137 (2020). https://doi.org/10.1038/s41415-020-1249-8

Descriptive Terminology for Oral Lesions

TermDefinition
AbscessLocalized collection of purulent exudate
AtrophyLoss of tissue resulting in thinning of the epithelium and usually associated with erythema
BullaFluid filled elevated lesion >5 mm in diameter
EcchymosisRed/purple macular area of submucosal hemorrhage/extravasated blood
EndophyticA lesion that is growing inwards into the underlying tissue
ErosionPartial loss of the surface epithelium not extending through the full thickness
ErythemaRedness of the mucosa usually caused by inflammation, atrophy of capillary dilatation
ExophyticA lesion that grows outwards from the surface epithelium
FissureLinear slit or groove in the skin or mucosa
FistulaAbnormal tract connecting two body cavities
FixedA lesion that is firmly attached to the overlying or underlying structures
HematomaA localized swelling filled with blood
InduratedHardening of soft tissue usually due to chronic inflammation or malignancy
MaculeCircumscribed discolored flat lesion not raised above level of surrounding mucosa
MobileA lesion that is freely movable and not attached to the overlying or underlying structures
NoduleCircumscribed elevated solid lesion >5 mm in diameter
PapillaryA lesion that has numerous surface projections
PapuleCircumscribed elevated solid lesion <5 mm in diameter
PedunculatedExophytic lesion attached to the underlying tissue by a stalk
PetechiaePin-point red or purple spots caused by submucosal hemorrhage
PlaqueSlightly elevated area of mucosa with a flat surface
PustuleCircumscribed raised lesion containing pus
ReticularResembling a net
SessileExophytic lesion attached to the underlying tissue by a broad base
UlcerBreak in continuity of the oral mucosa due to loss of full thickness of oral epithelium resulting in exposure of underlying connective tissue which is usually coated by a white or yellow membrane
VerrucousAn exophytic lesion with rough wartlike projections
VesicleFluid filled elevated lesion <5 mm in diameter

Specific Lesion Descriptions

Atrophy

  • Definition: Loss of tissue resulting in thinning of the epithelium and usually associated with erythema. Image from: Bhattacharya, Preeti Tomar & Misra, Satya. (2017). Effects of Iron Deficiency on the Oropharyngeal Region: Signs, Symptoms, and Biological Changes. 10.1007/978-3-319-40007-5_4-1.

Bulla

  • Definition: Fluid filled elevated lesion > 5 mm in diameter.
  • Blood filled Bulla: Haemorrhagic bulla. Images from: Ugo, Ordioni & Hadj Saïd, Mehdi & Thiery, G. & Campana, Fabrice & Catherine, jean-hugues & Lan, Romain. (2018). Angina bullosa haemorrhagica: a systematic review and proposal for diagnostic criteria. International Journal of Oral and Maxillofacial Surgery. 48. 10.1016/j.ijom.2018.06.015.

Ecchymosis, Petechiae, and Purpura

Erosion

  • Definition: Partial loss of the surface epithelium not extending through the full thickness. Image from: Okoh, Mercy & Omoregie, Osawe & Otakhoigbogie, Uwaila. (2015). PEMPHIGUS VULGARIS: A case report and literature review. AJOMPM. 1. 35-39.

Erythema

Exophytic

  • Definition: A lesion that grows outwards from the surface epithelium. Image from: Ripen, Z.M., Zainuddin, N.I. (2023). Painless Nodule on the Cheek: Fibroepithelial Polyp. In: Tilakaratne, W.M., Kallarakkal, T.G. (eds) Clinicopathological Correlation of Oral Diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-24408-7_18

Fissure

  • Definition: Linear slit or groove in the skin or mucosa. Image from: Malik, Mohammed et al. Burning red tongue with grooves, JAAD Case Reports, Volume 5, Issue 10, 923 - 924

Papillary

  • Definition: A lesion that has numerous surface projections. Image from: Betz, S.J. HPV-Related Papillary Lesions of the Oral Mucosa: A Review. Head and Neck Pathol 13, 80–90 (2019). https://doi.org/10.1007/s12105-019-01003-7

Reticular Striae

  • Definition: Resembling a net/lace-like pattern. Image from: González-Moles MÁ, Keim-del Pino C, Ramos-García P. Hallmarks of Cancer Expression in Oral Lichen Planus: A Scoping Review of Systematic Reviews and Meta-Analyses. International Journal of Molecular Sciences. 2022; 23(21):13099. https://doi.org/10.3390/ijms232113099

Plaque

  • Definition: Slightly elevated area of mucosa with a flat surface.
  • Homogenous: Same colour, consistency, texture throughout the entire lesion.
  • Non-homogenous: Not the same colour, consistency, texture throughout the entire lesion. Image from: Van der Waal, I. Oral Leukoplakia: Present Views on Diagnosis, Management, Communication with Patients, and Research. Curr Oral Health Rep 6, 9–13 (2019). https://doi.org/10.1007/s40496-019-0204-8

Papule

  • Definition: Circumscribed elevated solid lesion <5 mm in diameter. Image, from: Nico, M.M., Fernandes, J.D., & Lourenço, S.V. (2011). Oral lichen planus

Ulcer

  • Definition: Break in continuity of the oral mucosa due to loss of full thickness of oral epithelium resulting in exposure of underlying connective tissue which is usually coated by a white or yellow membrane.
  • Indurated: Hardening of soft tissue usually due to chronic inflammation or malignancy. Images from: Rawlings N, Willis A. Oral Ulceration - Clinical Feature. JIDA. Published online April 13, 2023. doi:10.58541/001c.74191 Fourie, J, & Boy, SC. (2016). Oral mucosal ulceration - a clinician’s guide to diagnosis and treatment. South African Dental Journal, 71(10), 500-508.

Identify the Characteristic Features of Lesions that Suggest Serious Pathology

When is a Referral Considered Urgent?

  • WHO, WHAT, WHEN, WHERE, WHY/HOW?
  • Is there a chance of malignancy?

Squamous Cell Carcinoma

  • Description: Irregular, ulcerated, and exophytic (raised) growth with a rough, keratinized surface.
  • Surrounding Tissue: Inflamed and erythematous.

Patient-Associated Risks (Who?)

  • Age
  • Gender
  • Medical status
    • Immunocompromised?
    • Previous history of cancer?
    • Loss of weight?
  • Habits and behaviours
    • Smoking status
    • Alcohol intake
    • Betel quid, areca nut
    • Alcohol-containing mouthwash use

’Red Flag’ Features of Oral Mucosal Disease

  • Oral ulcers that have lasted for more than 2 weeks
  • Oral ulcers that recur
  • Nontraumatic oral ulcers in children
  • Pigmented lesions on the oral mucosa
  • Red, white or mixed red and white lesions on the oral mucosa of unknown origin or with features of potentially malignant disease, such as:
    • Induration
    • Ulceration with rolled margins
    • Fixation to underlying tissues
    • Lesions in high-risk sites (eg lateral tongue, floor of mouth)
  • Facial or oral paraesthesia
  • Persistent oral mucosal discomfort with no obvious cause
  • Lumps or swellings, including lymphadenopathy
  • Swelling, pain or blockage of a salivary gland, suggestive of salivary gland disease (eg see Figure 13.9 for common causes of salivary gland swellings)
  • Suspected allergy or adverse reaction to dental materials (eg oral lichenoid lesion)
  • Dry mouth that is not adequately relieved with artificial salivary products and nonpharmacological methods
  • Dry mouth caused by systemic disease
  • Suspected oral manifestations of systemic disease (eg syphilis, Behçet syndrome, HIV, inflammatory bowel disease, lichen planus, pemphigoid

Assessment of Oral Mucosal Disease

  • lesions occurring in immunocompromised patients (eg patients with neutropenia or HIV infection)

# Identify the Characteristic Features of Lesions that Suggest Serious Pathology

UlcersRed/White lesionsPigmented lesionsLumps/Mass/SwellingPersistent pain or Neurological symptomsTrismusDry mouthOral manifestations of systemic diseases

# When?

  • Duration: ⏳
  • > 2 Weeks: ✅
  • Early referral to an oral medicine specialist: ✉️ (The University of Western Australia logo is present in the top right corner.)

# Where?

  • Location of lesion

High Risk Sites

Tongue
Floor of Mouth
Soft Palate
U R G E N T

# Why? Or… How?

  1. Reported trauma? →
    • Remove traumatic agent →
    • Review in 2 weeks →
    • Lesion persistent? → Early Referral
  2. Oral manifestation of systemic condition? → Early Referral
  3. Unsure of trigger? → Early Referral

Source: The University of Western Australia
This flowchart illustrates a decision-making process for determining whether early referral is necessary based on trauma, systemic conditions, or unclear triggers.

# Use the 5 Ws to Create Your Referral Letter

  • Who?
  • What?
  • When?
  • Where?
  • Why? Or, How?
  • Add the clinical photograph
  • Call the specialist if urgent!!!

# Be Able to Recognise Some Common Oral Lesions

  • Geographic tongue
  • Benign alveolar ridge keratosis
  • Traumatic ulcers
  • Oral candidosis
  • Recurrent aphthous stomatitis
  • Fibroepithelial polyp
  • Actinic cheilitis
  • Oral lichen planus
  • Oral leukoplakia

# Be Able to Recognise Some Common Oral Lesions

Geographic Tongue, Benign Migratory Glossitis, Erythema Migrans

  • Chronic, benign inflammatory condition of the tongue
  • Relapsing-recurring loss of filiform papillae
  • Affects 1-2% of population
  • Patients often seek professional advice due to unusual appearance of tongue or increased sensitivity to spicy or acidic foods
  • Exact aetiology unknown
    • Linked to atopic patients; Eczema, Asthma, food sensitivities, Psoriasis
  • Clinical features:
    • Often asymptomatic, or some burning/sensitivity to acidic or spicy foods
    • Frequently presents on dorsal or ventral tongue
    • Begins as one ore more depapillated areas which enlarge to form slightly depressed, red patches with a white surrounding rim
    • Results in a map like pattern = “Geographic tongue”
    • Self limiting, heals within few days
  • Diagnosis: Clinical diagnosis, biopsy usually unnecessary
  • Management:
    • Asymptomatic: No treatment indicated, education, reassurance
    • Symptomatic: 2% viscous lidocaine, benzydamine hydrochloride (Difflam), mild topical corticosteroids Fig. 12 (a) Benign migratory glossitis characterized by macular erythema with atrophy of filiform papillae and slightly elevated white, circinate borders. (b) Benign migratory glossitis characterized by patchy depapillation of the dorsum with only faint white rim. (c) Migratory stomatitis: white circular and linear lesions of the lower lip mucosa

Benign Alveolar Ridge Keratosis

  • Benign, frictional/traumatic hyperkeratosis on keratinised alveolar ridge mucosa or palatal mucosa
  • Results from mechanical trauma, likely from food crushed against edentulous alveolar ridge
  • Oral mucosa responds with deposition of keratin and benign epithelial hyperplasia
  • Most common in 5th-6th decades of life
  • Clinical features:
    • Asymptomatic, poorly demarcated white plaque
    • Mandibular retromolar pad, edentulous maxillary or mandibular alveolar ridge mucosa
    • Surface often rough, slightly verrucous
  • Diagnosis: Biopsy may be performed to establish diagnosis, rule out dysplasia
  • Management: Benign lesion with no malignant potential, no treatment required. Should be differentiated from leukoplakia which has malignant potential. Fig. 6 Benign alveolar ridge ketatosis: poorly demarcated white plaque of the (a) right retromolar pad and (b) left retromolar pad

Traumatic Ulcers

  • Reactive oral ulcers: trauma affecting mucosal lining of mouth
  • Self-inflicted
  • Mechanical trauma – sharp margins of teeth, prosthesis, denture flange, self-biting, factitious injuries
  • Ulcer: complete loss of epithelium which exposes the underlying connective tissues
  • Clinical presentation:
    • Mechanical: areas or erythema surrounding a central removable, yellow fibrinopurulent membrane
    • Can develop a rolled white border of hyperkeratosis immediately adjacent the area of ulceration
    • Can affect any oral mucosal surface – tongue, lips, buccal mucosa
  • Diagnosis:
    • History
    • Clinical presentation
    • Identify trauma
    • Resolve spontaneously once causative factor has been identified and removed (10-14 days)
  • Management:
    • Identify trauma
    • Resolve spontaneously once causative factor has been identified and removed (10-14 days)
    • Chlorhexidine gel, mouthrinse
    • Lignocaine gel, Benzydamine hydrochloride mouthrinse (Difflam)
    • Review after treatment, if lesion persists, further investigations are warranted including biopsy to rule out malignancy Traumatic ulcer from sharp tooth Oral squamous cell carcinoma

Oral Candidosis

  • Most common fungal infection in the mouth
  • Caused by Candida albicans
  • Pseudomembranous candidosis:
    • White, curdy papules and plaques can be scraped off mucosal surface leaving behind erythematous, bleeding mucosa
    • Occurs in: Recent antibiotic use, steroid therapy, immunocompromised patients
  • Erythematous candidosis:
    • Erythematous, raw-appearing lesions of oral mucosa
    • Occurs in: Denture use: well-delineated erythema limited to denture bearing areas, common on hard palate
    • Median rhomboid glossitis: atrophy of midline of dorsal tongue
    • Angular cheilitis: painful erythema and fissuring on corners of lips
  • Diagnosis:
    • Clinical diagnosis
    • Can confirm with cytology, scrape, swab
  • Patient management:
    • Topical and systemic antifungal medications: nystatin, miconazole, amphotericin
    • Management of prosthesis a b C d Fig. 10 (a) Pseudomembranous candidosis: white plaques and papules and erythema involving the hard and soft palate. (b) Erythematous candidosis: erythema of the palatal mucosa beneath a denture. (c) Median rhomboid glossitis and angular cheilitis in an edentulous after antibiotic therapy. (d) Angular cheilitis: erythematoos, macerated areas at the commissures

Recurrent Aphthous Stomatitis

  • Common oral mucosal disease affects 10 – 20% of general population
  • Recurring ulcers of oral mucosa, manifesting first in childhood or adolescence in patients with no other systemic diseases
  • Can present as minor, major, herpetiform and severe
    • Minor aphthous stomatitis:
      • Most common form
      • < 1 cm in diameter, single or multiple
      • Round, shallow, symmetric
      • Painful when present (first 3-4 days), usually last 7-10 days
      • Heal without scarring
    • Major aphthous stomatitis:

      • 1 cm diameter, deep, extremely painful lesions

      • Interfere with speech
      • Last for weeks or months
      • Health with scar formation
    • Herpetiform aphthous stomatitis:
      • Rare variant with multiple small ulcers
      • Few millimetres with crop-like appearance, coalesce to form large lesion with irregular margin
      • Heal within 7 – 10 days
    • Severe aphthous stomatitis:
      • Variant in which patients are almost never ulcer free
      • Chronic pain, malnutrition, weight loss
      • Develop new ulcers when previous ones are healing

Recurrent Aphthous Stomatitis

  • Diagnosis: – History – Laboratory tests may be helpful: rule out haematological deficiencies and systemic conditions – Biopsies to rule out vesiculobullous disorders
  • Management – Treatment may not be necessary as pain is tolerable and does not interfere with daily life – Reduce pain and frequency – 10% benzocaine, viscous lidocaine, benzydamine hydrochloride – Reassurance and patient education – Topical corticosteroids and other immunosuppressive agents can be used for more severe ulcers to shorten duration and size of ulcers

Fibroepithelial Polyp

  • Fibrous nodule
  • Induced by recurrent local irritants of oral cavity –bite trauma, denture irritation, food impaction, poor oral hygiene
  • Pathophysiology: Reactive proliferation rather than true neoplasm
  • Clinical Features
    • Smooth, round, exophytic nodule
    • Pedunculated or sessile with normal overlying epithelium
    • Can be ulcerated, or demonstrate thickened white surface (hyperkeratosis)
    • Asymptomatic generally
    • 1-2 cm in diameter
    • Labial mucosa, tongue, palate
  • Diagnosis
    • Definitive diagnosis made upon histopathological examination
    • Highly suspected based on clinical features
  • Treatment
    • Surgical excision with removal of local irritants

Oral Leukoplakia

  • WHO defines OLK as “a predominantly white plaque of questionable risk having excluded (other) known diseases or disorders that carry no increased risk for cancer”.
  • Six times more prevalent in smokers and use of alcohol
  • Risk of malignant transformation: 0.13% and 36.4%
  • Homogenous:
    • Sharply demarcated
    • Uniform white plaque
    • Smooth, fissured, wrinkled surface
    • Consistent surface topography throughout
  • Non-homogenous leukoplakia
    • Verrucous
    • Nodular
    • Speckled (erythroleukoplakia)
    • Palpate for firmness or induration
  • Clinical diagnosis
  • Biopsy to exclude dysplasia or malignancy
  • Management: clinical surveillance vs excision

So, Are All White Lesions Leukoplakia?

DevelopmentalFordyce’s granules
White sponge nevus
ReactiveFrictional keratosis
Chemical injury
Morsciato mucosae oris
Leukoedema
Smokeless tobacco keratosis
Nicotinic stomatitis
InfectionsCandidosis
Oral hairy leukoplakia
Immune-Mediatedand Geographic tongue
Autoimmune conditionsOral lichen planus and lichenoid reactions

Oral Lichen Planus

  • Chronic, immune-mediated, inflammatory disorder with characteristic relapses and remissions
  • Display reticular lesions
  • Accompanied or not by atrophic, erosive, ulcerative and/or plaque type areas
  • Diagnosis: clinical and histopathology
  • Management: Topical or systemics corticosteroids, immunosuppressive treatment
  • Regular monitoring advised to monitor disease activity, symptomology and prevent malignant transformation
  • 0.44% - 1.4%
  • Higher in smokers, excessive alcohol intake, non-reticular types | Clinical criteria | Presence of bilateral, more or less symmetrical white lesions affecting buccal mucosa, and/or tongue, and/or lip, and/or gingiva | | :-------------------------------- | :----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | | Presence of white papular lesions and lace-like network of slightly raised white lines (reticular, annular, or linear pattern) with or without erosions and ulcerations | | | Sometimes presents as desquamative gingivitis | | Histopathological criteria | Presence of a well-defined band-like predominantly lymphocytic infiltrate that is confined to the superficial part of the connective tissue | | | Liquefactive degeneration of the basal cell layer | | | Epithelial thinning and sometimes ulceration caused by failure of epithelial regeneration as a result of basal cell destruction seen in atrophic subtype. Mixed inflammatory infiltrate may be found | Endorsed Diagnostic criteria of oral lichen planus based on Oral potentially malignant disorders: A consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral Cancer

Be Able to Recognise Some Common Oral Lesions

Be Able to Recognise Some Common Oral Lesions

  • 68 year old female, non-smoker, biopsy proven oral lichen planus
  • Lost to follow up since 2019
  • Presented December 2021 complaining of six month history of tongue pain

Actinic Cheilitis

  • Clinical term
  • Response to chronic sun exposure
  • Blurred vermilion border
  • White
  • Red-white plaques
  • Ulcerated/pigmented lesions
  • Solar elastosis seen in histopathology
  • Vary from hyperkeratosis, dysplasia and early squamous cell carcinoma
  • Risk of malignant transformation varies from 10 % to 30%
  • 95% of SCC on the lower lip develop on a pre-existing actinic cheilitis
  • Diagnosis: clinical and histopathological
  • Investigations: Biopsy to rule out dysplasia or malignancy
  • Management: clinical surveillance, sun protection, excision

# Take Home Messages

  • Important to understand normal anatomy
  • Develop a systematic soft tissue examination method in order to avoid missing important anatomical sites
  • Always palpate the lymph nodes
  • Always take a clinical photograph of any lesions that you note
  • Remember CLOTHS when describing lesions
  • Remember the 5Ws (Who, What, When, Why, How/Why) when you see an oral lesion?
  • If oral lesion present for > 2 weeks, or unable to identify a trigger consider an early referral to an oral medicine specialist
  • Use the 5Ws to create your referral letter – include the clinical photograph
  • Oral leukoplakia, Actinic cheilitis and Oral lichen planus are common oral conditions which carry risk of malignant transformation and require specialist care

# Any Questions?

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