Pocket Atlas of Oral Diseases. George Laskaris

tests: Histopathologic examination.

       Differential diagnosis: Verruca vulgaris, condyloma accuminatum, sialadenoma papilliferum, verruciform xanthoma, verrucous carcinoma, focal epithelial hyperplasia, and focal dermal hypoplasia syndrome.

      Treatment: The treatment of choice is surgical excision.

      Fig. 1.45 Papilloma on the lateral aspect of the tongue.

1.22 Verrucous Carcinoma

      Definition: Verrucous carcinoma is a low-grade variant of squamous cell carcinoma.

      Etiology: The exact etiology is unknown. Smoking and HPV types 16, 18, and 33 are involved in the pathogenesis.

      Clinical features: Clinically, verrucous carcinoma presents as a slowly growing, painless, exophytic mass with a characteristic cauliflower-like whitish surface (▶ Fig. 1.46). The size ranges from 1 cm to several centimeters if left untreated. The buccal mucosa, tongue, palate, and alveoral mucosa are the most common sites of involvement. The tumor more frequently affects males than females (ratio 2:1) older than 60 years of age. The clinical diagnosis should be confirmed histologically.

      Laboratory tests: Histopathologic examination.

       Differential diagnosis: Papilloma, verrucous hyperplasia, verrucous leukoplakia, verruciform xanthoma, squamous cell carcinoma, and white sponge nevus.

      Treatment: The treatment of choice is surgical excision.

      Fig. 1.46 Early verrucous carcinoma on the dorsum of the tongue.

1.23 Squamous Cell Carcinoma

      See also sections 2.9, 5.16, 6.7, and 8.2.1.

      Definition: It is the most common malignant neoplasm of the oral cavity and accounts for 95% of oral malignancies.

      Etiology: The exact etiology remains unknown. However, many intrinsic and extrinsic factors have been implicated. The most important are smoking, alcohol consumption, chemicals, HPV types 16 and 18, diet, sunlight exposure (lips), immunodeficiency, oncogenes, and tumor suppressor genes.

      Clinical features: Squamous cell carcinoma presents with a great clinical polymorphism. In about 5 to 8% of cases, it appears in the early stages as an asymptomatic white irregular plaque similar to leukoplakia (▶ Fig. 1.47). The clinical diagnosis should be confirmed by biopsy and histologic examination.

      Laboratory tests: Histopathologic examination.

       Differential diagnosis: Verrucous carcinoma, leukoplakia, papilloma, verruca vulgaris, and verruciform xanthoma.

      Treatment: Surgical excision with or without radiotherapy and/or chemotherapy.

      Fig. 1.47 Early squamous cell carcinoma, mimicking leukoplakia, on the lower gingiva.

1.24 Skin and Mucosal Grafts

      Definition: Skin and mucosal grafts are often utilized in the mouth to cover mucosal defects after extensive surgery for benign and more frequently for malignant tumors, or as free gingival graft.

      Clinical features: Clinically, both skin and mucosal grafts usually present as a whitish or gray-white plaque (▶ Fig. 1.48). Occasionally, the color of the skin graft is black, due to melanin overproduction. If the skin graft contains hair follicles, it may develop hair in the oral cavity. The tongue, buccal mucosa, palate, gingiva, and alveoral mucosa are the most common sites where either grafts are placed. The diagnosis is based on the history and clinical features.

       Differential diagnosis: Leukoplakia, traumatic scar, epidermolysis bullosa, and benign tumors.

      Treatment: No treatment is required.

      Fig. 1.48 Skin graft on the lateral border of the tongue.

1.25 Epithelial Peeling

      Definition: Epithelial peeling or epitheliolysis is a relatively common superficial desquamation of the oral mucosa.

      Etiology: It is usually caused by the direct irritating effect of toothpastes that contain sodium lauryl sulfate or pyrophosphates. The same phenomenon may be associated with chlorhexidine mouthwash, while, occasionally, the lesions are idiopathic.

      Clinical features: Clinically, epithelial peeling appears as a superficial, asymptomatic white membrane or plaque or dots that can be easily detached from the oral mucosa (▶ Fig. 1.49 and ▶ Fig. 1.50). The buccal mucosa and the mucobuccal folds are more frequently affected. The lesions usually disappear when patients stop using the causative mouthwash or toothpaste. The diagnosis is based on the history and clinical features.

       Differential diagnosis: Chronic biting, candidiasis, cinnamon contact stomatitis, thermal or chemical burn, and leukoedema.

      Treatment: No treatment is necessary other than cessation of the causative agents.

      Fig. 1.49 Epithelial peeling.

      Fig. 1.50 Epithelial peeling.