Clinical Discussion Case
Patient Profile and History1
- Patient: 58-year-old female
- Medical History: Hypertension
- Social History: Non-smoker; social alcohol consumption
- Dental History: Wears a removable partial denture
- Chief Complaint: Troublesome gingival lesion in the 21 region
- Previous Diagnosis: 2-year history of oral lichen planus
Identify the pathosis and describe the clinical features.
- Red and white patches on gingiva
- ulcer
What is the differential diagnosis?
- SCC
- Lichenoid drug reaction
- due to medications for hypoertension
- Lichen Planus
- Traumatic ulcer
What are the relevant clinical investigations?
Make sure to look at the denture
that its seating well and not irritating the gingiva
- Ask the paitent how she manages the lichen planus:
- she uses topical corticosteroids and bethamethasone ointment to settle flare ups
- her flareups settle within a few days and she stops the ointment, but this area she has been treating it daily for 6 weeks
- she uses topical corticosteroids and bethamethasone ointment to settle flare ups
Treatment of Traumatic vs Inflammatory Ulcers
- You shouldn’t treat traumatic ulcers with topical corticosteroids, but you can treat inflammtory ones with them
Blood Tests
Glucose tolerance
- we don’t know if the patient is diabetic
Dentures
- adjustment or asking patient to stop earing them
Biopsy
- she is at 1% risk of malignancy due to having OLP
- We are worried about swelling because lichen planus is flat so there shouldn’t be any swelling
Histology
- Nuclear pleomorphism
- Lymphocytic infiltrate
- Mitotic figures The histology is classic for a sqaumous cell carcinoma
What is the diagnosis?
- Early Squamous cell carcinoma that has developed
How would you manage this patient?
- should still make the patient wait 2 weeks without hte dneture, as those two weeks wont make a difference , but two months will
Footnotes
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Original PDF page 1: 9. epithelial Pathosis II, p.1 ↩