Quartz 4

8. OPMDs_integrated

2 min read

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.

Clinical appearance

Highlight

The lesion was predominantly erythematous (red) with well-defined borders and subtle white specks within the red area, located on the gingiva.

Medical and Social History

  • Medical History: Significant for hypercholesterolaemia and depression.
  • Social History: Non-smoker; does not consume alcohol.

Questions

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
    • Iron levels should also be checked as part of the hematinics screen.

Fasting glucose

Full blood count

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

Diagnostic red flags

Highlight

  • Solitary "fiery red" lesions on the gingiva that do not respond to hygiene measures.
  • Rapid change in color or texture (e.g., new white patches on a red base).
  • Unexplained bone loss or loss of dental papilla.
  • If an inflammatory condition is suspected, tissue should be sent for H&E staining and Direct Immunofluorescence (DIF) to rule out autoimmune conditions like Lupus.
  • Even if stable, repeat biopsies are recommended at least every two years.

Management

  • 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

  1. Original PDF page 1: OPMD Case 2, p.1 ↩

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