Clinical Discussion Case Of Oral Lesion
Patient Presentation and History1
A 62-year-old female presents with a lesion on the buccal mucosa. The patient first noticed the lesion three to four months ago. While she remains mostly asymptomatic, she reports occasional irritation at the site, specifically triggered by the consumption of spicy or acidic foods.
Medical and Social History
- Medical History: Significant for hypercholesterolaemia and depression.
- Social History: Non-smoker; does not consume alcohol.
Case Description And Patient History
Identify the pathosis and describe the clinical features.
What is the differential diagnosis?
- erythroplakia
- -inflammatory conditions
- desquamative gingivitis
- lichen planus
What are the relevant clinical investigations?
Biopsy
- can be a single biopsy because the lesion looks pretty much the same
Hematinics
- because the leukoplakia was ulcerated , but even if it wasn’t:
- b12 and folate deficiencies can be associated with dysplastic lesions
Fasting glucose
Full blood count
What is the diagnosis?
- after lab report its lichen planus
- because we have liqufactive degeneration of the basal cell layer
- BUT lichen planus has to be symmetric and bilateral therefore because the patient presents wit ha solitary lesion therefore it becomes
- Oral lichenoid lesion
How would you manage this patient?
- Follow up over time, if it develops into bilateral symmetric lesions then it turns into lichen planus
What if lesion spreads
- then it needs a biospy
- in this case it turned into an OSCC
Footnotes
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Original PDF page 1: OPMD Case 2, p.1 ↩