Case #3 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 Differrential Diagnosis: Leukoedema   ~Location – Buccal Mucosa Hyperkeratosis, Epithelial Dysplasia, Carcinoma in situ, and Squamous Cell Carcinoma   ~Would not be present from childhood   ~These lesions usually would not cover such a large area   ~These lesions are not bilaterally symmetrical Lichen Planus   ~Would not be present from childhood   ~Often has a characteristic appearance, which is not exhibited here Nicotinic Stomatitis   ~Not diffuse   ~Location – Hard Palate Hairy Tongue   ~Not diffuse   ~Location – Tongue Hairy Leukoplakia   ~Patient is not immunocompromised Geographic Tongue (Erythema Migrans)   ~Not diffuse   ~Location – Tongue   ~Appearance – Red with thin, white border Lesions to Include in Differential Diagnosis: Familial Epithelial Hyperplasia   ~Young patient who has had this for as long as he remembers (congenital)   ~Has always been in the same locaton and have not changed   ~Family has similar lesions 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.  Routine regular dental exams are recommended. Final Diagnosis: Familial Epithelial Hyperplasia (White Sponge Nevus)