Case #2 Discussion

Summary: This is a white surface lesion. It is white due to epithelial thickening because it is rough, asymptomatic, and will not rub off. Lesions to Exclude from Differential Diagnosis: Leukoedema   ~Location – Bilateral buccal mucosa Epithelial Dysplasia, Carcinoma in Situ, and Squamous Cell Carcinoma   ~These lesions are usually not bilateral and symmetrical. Lichen Planus   ~Location and appearance. Although it can be on the tongue, it typically involves the buccal mucosa. Nicotinic Stomatitis   ~Location – Hard palate Familial Epithelial Hyperplasia (White Sponge Nevus)   ~Diffuse and multifocal   ~Present from early childhood   ~May have a familial history. Hairy Tongue   ~Location – Would include the dorsum of the tongue Hairy Leukoplakia   ~Can be excluded once patient’s immune function is determined. Geographic Tongue (Erythema Migrans)   ~Erythematous with irregular, thin, white border. Lesions to Include in Differential Diagnosis: Hyperkeratosis   ~Probably due to chronic irritation by tooth trauma. Management: Explain to the patient the cause and diagnosis of the lesion. That way if the lesion is noticed by another health care professional, the patient will not be alarmed.  Recommend that the patient stop chewing the tongue and follow up in 3-4 weeks Final Diagnosis: Hyperkeratosis, consistent with tongue chewing