Clinical Case Discussion: Asymptomatic Oral Lesion
Patient Presentation1
A 78-year-old male presents with an asymptomatic oral lesion. The patient has been aware of the lesion’s presence for approximately two years.
Medical and Social History
- Medical History: Significant for hypertension, hypercholesterolaemia, and ischaemic heart disease.
- Social History: Past smoker; currently consumes six alcoholic drinks per day.
Identify the pathosis and describe the clinical features.
What is the differential diagnosis?
- lichen planus
- leukoplakia
- Frictional keratosis
What are the relevant clinical investigations?
Blood test
Hematinics
- cus of ulcer
Full blood count
Liver Function
Coagulation
Biopsy
-
take the worst looking area
-
take a sample from further back
-
after lab report we get atypia , in the lowe rthrid
- thus mild epithelial dysplasia
- so we have to rule out lichen planus because theres dysplasia
What is the diagnosis?
- After lab report we can tell its leukoplakia
How would you manage this patient?
If leukoplakia there are only 2 options:
- observe
- excise
- downsides:
- large lesion so its excessive
- doesn’t guarantee that the lesion won’t recur
- downsides:
We also want to try and get the ulcer to heal:
- so chlorhexidine to try and heal it
Recall intervals
- first couple visits after ulcer healing
- 3 months
- Then if the lesion is doing nothing (not changing)
- keep patient on 6 monthly review
- Recalls remain forever as their risk is for life
- the highest risk is within 5 years, if the lesion has been there for longer than five years then you’ll see them once a year
Risk determination of leukoplakia
- readings
- premalignant conditions of the oral cavity
Footnotes
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Original PDF page 1: OPMD Case 1, p.1 ↩