common oral lesions

Graphic artist: James Bouquot, Morgantown, WV

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The 53 Most Common Oral LesionsThe 53 Most Common Oral Lesions This presentation created by Dr. J. E. BouquotThis presentation created by Dr. J. E. Bouquot

Data from the Minnesota Oral Disease Prevalence ProjectData from the Minnesota Oral Disease Prevalence Project

Disclaimer: Dr. Bouquot is now the Chair of theDepartment of Diagnostic Sciences,

University of Texas Dental Branch at Houston.The information and opinions provided herein are,

however, his own and do not represent official opinion or policy of the University of Texas.

Jerry Bouquot, DDS, MSD, DABOMP, FICD, FADI, FACDJerry Bouquot, DDS, MSD, DABOMP, FICD, FADI, FACD

St. Olaf College, Minnesota (BA) Univ. Minn. (DDS, MSD in oral pathology) Bone Pathology Fellowship, Mayo Clinic Odontogenic Pathology Fellowship, Royal College of Dent., Copenhagen, Denmark Career Dev. Award, Amer. Cancer Soc. Chair, Dept. Oral Path., WVU (17 years) President, American Board of Oral & Maxillofacial Pathology (1998-1999) St. George National Award, Am. Cancer Soc. Consultant, Pittsburgh Children’s Hospital Director of Research, MFCenter Oral Cancer Control Coordinator, WV Bureau for Public Health Adjunct Professor, WVU School of Dentistry Professor & Chair, Diagnostic Sciences, University of Texas Dental Branch, Houston

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The 53 Most Common Oral LesionsThe 53 Most Common Oral Lesions This presentation created by Dr. J. E. BouquotThis presentation created by Dr. J. E. Bouquot

Data from the Minnesota Oral Disease Prevalence ProjectData from the Minnesota Oral Disease Prevalence Project

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The 53 Most Common Oral LesionsThe 53 Most Common Oral Lesions(Excluding Caries & Periodontal Disease)(Excluding Caries & Periodontal Disease)

The 15 Most Common Oral PathosesThe 15 Most Common Oral Pathoses(Based on examination of 23,616 U.S. adults; excludes caries & periodontitis)(Based on examination of 23,616 U.S. adults; excludes caries & periodontitis)

References: Bouquot JE. J Am Dent Assoc 1986; 112:50-57; www.oralpath.com

DiagnosisDiagnosis RankRank

Number of Lesions per 1,000 AdultsNumber of Lesions per 1,000 Adults

MalesMales FemalesFemales BothBoth

LeukoplakiaLeukoplakia 11 42.542.5 13.113.1 23.723.7

Torus palatinusTorus palatinus 22 13.213.2 21.721.7 18.718.7

Irritation fibromaIrritation fibroma 33 13.013.0 11.411.4 11.911.9

Fordyce granulesFordyce granules 44 17.717.7 5.25.2 9.79.7

Torus mandibularisTorus mandibularis 55 9.69.6 7.97.9 8.58.5

Leaf-shaped fibroma (under denture)Leaf-shaped fibroma (under denture) 66 0.40.4 12.912.9 6.76.7

HemangiomaHemangioma 77 8.48.4 4.14.1 5.65.6

Inflammatory ulcerInflammatory ulcer 88 5.45.4 5.15.1 5.25.2

Inflammatory erythemaInflammatory erythema 99 4.54.5 4.84.8 4.74.7

PapillomaPapilloma 1010 5.35.3 4.24.2 4.64.6

Epulis fissuratumEpulis fissuratum 1111 3.43.4 4.44.4 4.04.0

Lingual varicositiesLingual varicosities 1212 3.53.5 3.43.4 3.53.5

Fissured tongueFissured tongue 1313 3.53.5 3.13.1 3.33.3

Geographic tongueGeographic tongue 1414 3.43.4 3.03.0 3.13.1

Papillary hyperplasia of palatePapillary hyperplasia of palate 1515 1.71.7 3.83.8 3.03.0

The 16The 16thth – 30 – 30thth Most Common Oral Pathoses Most Common Oral Pathoses(Based on examination of 23,616 U.S. adults; excludes caries & periodontitis)(Based on examination of 23,616 U.S. adults; excludes caries & periodontitis)





Herpes labialisHerpes labialis 1616 2.42.4 2.62.6 2.52.5

MucoceleMucocele 1717 1.91.9 2.62.6 2.42.4

Scar tissueScar tissue 1818 2.42.4 1.91.9 2.12.1

Angular cheilitisAngular cheilitis 1919 1.81.8 1.91.9 1.91.9

Smokeless tobacco keratosisSmokeless tobacco keratosis 2020 4.24.2 0.20.2 1.71.7

Lingual tonsil, hyperplasticLingual tonsil, hyperplastic 2121 2.42.4 1.21.2 1.61.6

Hematoma/EcchymosisHematoma/Ecchymosis 2222 1.91.9 1.31.3 1.51.5

Frictional keratosis (cheek bite)Frictional keratosis (cheek bite) 2323 0.70.7 1.41.4 1.11.1

Lichen planusLichen planus 2424 1.21.2 1.11.1 1.11.1

Squamous cell carcinomaSquamous cell carcinoma 2525 2.52.5 0.10.1 0.90.9

Buccal exostosisBuccal exostosis 2626 0.90.9 0.90.9 0.90.9

Amalgam tattooAmalgam tattoo 2727 0.60.6 1.01.0 0.80.8

Median rhomboid glossitisMedian rhomboid glossitis 2828 0.80.8 0.50.5 0.60.6

Hairy tongue, black , white, etc.Hairy tongue, black , white, etc. 2929 1.21.2 0.30.3 0.60.6

Atrophic glossitis (smooth tongue)Atrophic glossitis (smooth tongue) 3030 0.60.6 0.50.5 0.60.6

The 31The 31stst – 45 – 45thth Most Common Oral Pathoses Most Common Oral Pathoses(Based on examination of 23,616 U.S. adults; excludes caries & periodontitis)(Based on examination of 23,616 U.S. adults; excludes caries & periodontitis)





Nicotine palatinusNicotine palatinus 3131 1.21.2 0.20.2 0.60.6

Epidermoid cystEpidermoid cyst 3232 0.70.7 0.40.4 0.50.5

Intramucosal (“intradermal”) nevusIntramucosal (“intradermal”) nevus 3333 0.10.1 0.70.7 0.50.5

Melanotic maculeMelanotic macule 3434 0.50.5 0.30.3 0.40.4

Oral tonsil, hyperplastic (non-lingual)Oral tonsil, hyperplastic (non-lingual) 3535 0.50.5 0.30.3 0.40.4

LeukoedemaLeukoedema 3636 0.40.4 0.30.3 0.30.3

Shingles, intraoral (herpes zoster)Shingles, intraoral (herpes zoster) 3737 0.50.5 0.20.2 0.30.3

LipomaLipoma 3838 0.10.1 0.40.4 0.30.3

Candidiasis, pseudomembranous (acute)Candidiasis, pseudomembranous (acute) 3939 0.40.4 0.20.2 0.30.3

Herpes simplex (secondary), intraoral Herpes simplex (secondary), intraoral 4040 0.10.1 0.30.3 0.20.2

RanulaRanula 4141 0.20.2 0.10.1 0.20.2

Sialolithiasis (salivary stone)Sialolithiasis (salivary stone) 4242 0.00.0 0.30.3 0.20.2

Bifid uvulaBifid uvula 4343 0.40.4 0.00.0 0.10.1

White coated tongueWhite coated tongue 4444 0.40.4 0.00.0 0.10.1

Gingival hyperplasia (not routine gingivitis)Gingival hyperplasia (not routine gingivitis) 4545 0.10.1 0.10.1 0.10.1

The 46The 46thth – 53 – 53rdrd Most Common Oral Pathoses Most Common Oral Pathoses(Based on examination of 23,616 U.S. adults; excludes caries & periodontitis)(Based on examination of 23,616 U.S. adults; excludes caries & periodontitis)



Number of Lesions per 1,000 Number of Lesions per 1,000 AdultsAdults


Buccinator lymph node, hyperplasticBuccinator lymph node, hyperplastic 4646 0.10.1 0.10.1 0.10.1

Commisural lip pit(s)Commisural lip pit(s) 4747 0.10.1 0.10.1 0.10.1

Cyst of Blandin-Nuhn (mucocele, ventral of tongue)Cyst of Blandin-Nuhn (mucocele, ventral of tongue) 4848 0.00.0 0.10.1 0.10.1

MacroglossiaMacroglossia 4949 0.00.0 0.10.1 0.070.07

Pyogenic granulomaPyogenic granuloma 5050 0.00.0 0.10.1 0.070.07

Nasoalveolar cystNasoalveolar cyst 5151 0.00.0 0.10.1 0.070.07

Neurofibroma/schwannomaNeurofibroma/schwannoma 5252 0.00.0 0.10.1 0.060.06

Basal cell carcinoma, vermilion border of lipBasal cell carcinoma, vermilion border of lip 5353 0.10.1 0.00.0 0.040.04

Note: lesions not listed in the top 53 most common lesions were not seen during the examination of this large population-based, primarily white cohort in Minnesota.

Almost all examinees were 35 years of age or older; 2/3 were female.

#1 Lesion: Leukoplakia#1 Lesion: LeukoplakiaPrevalence:Prevalence: # Lesions/1,000 = 42.5 (Males), 13.1 (Females), 23.7 (Total)# Lesions/1,000 = 42.5 (Males), 13.1 (Females), 23.7 (Total)

© Photo: Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

Speckled leukoplakia (erythroleukoplakia)Speckled leukoplakia (erythroleukoplakia)

Verruciform (verrucous) leukoplakiaVerruciform (verrucous) leukoplakia

Differential Dx: Leukoplakia in Syphilitic GlossitisDifferential Dx: Leukoplakia in Syphilitic GlossitisCaution! Leukoplakia of the dorsum is rare & may represent tertiary syphilis.Caution! Leukoplakia of the dorsum is rare & may represent tertiary syphilis.

© Photo: Schwimmer, E. Arch Dermat Syph 1877; 9:611-570.

Differential Dx: Erythroleukoplakia (Speckled Leukoplakia)Differential Dx: Erythroleukoplakia (Speckled Leukoplakia)Caution! This type has the highest risk of malignant transformation.Caution! This type has the highest risk of malignant transformation.


Buccal mucosa; arrow points to carcinoma in situBuccal mucosa; arrow points to carcinoma in situ

#2 Lesion: Torus Palatinus#2 Lesion: Torus PalatinusPrevalence (# Lesions/1,000) = 13.2 for Males, 21.7 for Females, 18.7 TotalPrevalence (# Lesions/1,000) = 13.2 for Males, 21.7 for Females, 18.7 Total

© Photos: Dr. Patricia Hagen, West Virginia University, Morgantown, West Virginia; Dr. Thomas Wilcko, Erie, Pennsylvania

Mild caseMild case

#3 Lesion: Irritation Fibroma#3 Lesion: Irritation FibromaPrevalence (# Lesions/1,000) = 13.0 for Males, 11.4 for Females, 11.9 TotalPrevalence (# Lesions/1,000) = 13.0 for Males, 11.4 for Females, 11.9 Total

© Photos Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

#4 Lesion: Fordyce Granules#4 Lesion: Fordyce GranulesPrevalence (# Lesions/1,000) = 17.7 for Males, 5.2 for Females, 9.7 TotalPrevalence (# Lesions/1,000) = 17.7 for Males, 5.2 for Females, 9.7 Total


#5 Lesion: Torus Mandibularis#5 Lesion: Torus MandibularisPrevalence (# Lesions/1,000) = 9.6 for Males, 7.9 for Females, 8.5 TotalPrevalence (# Lesions/1,000) = 9.6 for Males, 7.9 for Females, 8.5 Total

© Photos: Dr. Thomas Wilcko, Erie, Pennsylvania; Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

#6 Lesion: Leaf-Shaped Fibroma#6 Lesion: Leaf-Shaped FibromaPrevalence (# Lesions/1,000) = 0.4 for Males, 12.9 for Females, 6.7 TotalPrevalence (# Lesions/1,000) = 0.4 for Males, 12.9 for Females, 6.7 Total

© Photos Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

May infarct if stalk becomes twistedMay infarct if stalk becomes twisted

#7 Lesion: Hemangioma#7 Lesion: HemangiomaPrevalence (# Lesions/1,000) = 8.4 for Males, 4.1 for Females, 5.6 TotalPrevalence (# Lesions/1,000) = 8.4 for Males, 4.1 for Females, 5.6 Total

© Top photo: Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia© Bottom photo: Dr. Richard Hart, West Virginia University, Morgantown, West Virginia

#8 Lesion: Inflammatory Ulcers *#8 Lesion: Inflammatory Ulcers *Prevalence (# Lesions/1,000) = 5.4 for Males, 5.1 for Females, 5.2 TotalPrevalence (# Lesions/1,000) = 5.4 for Males, 5.1 for Females, 5.2 Total

* estimated: 50% = aphthous ulcers & 50% = traumatic ulcers© Photos: Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

Aphthous UlcerAphthous Ulcer



Traumatic Ulcer on Traumatic Ulcer on Torus Palatinus, with Torus Palatinus, with Frictional KeratosisFrictional Keratosis

With Multiple Aphthae: Major Aphthous StomatitisWith Multiple Aphthae: Major Aphthous StomatitisSutton’ Disease, Periadenitis Mucosa Necrotica RecurrensSutton’ Disease, Periadenitis Mucosa Necrotica Recurrens

Multiple painful aphthae with deep ulcer beds

Photo: Dr. R. Hart, West Virginia University, Morgantown, West Virginia

Traumatic Ulcer & Hematoma of LipTraumatic Ulcer & Hematoma of LipCaution! May be a sign of child abuseCaution! May be a sign of child abuse

© Photo: Dr. Thomas Wilcko, Erie, Pennsylvania

Differential Dx: Traumatic Eosinophilic Ulcer Differential Dx: Traumatic Eosinophilic Ulcer A different kind of traumatic ulcerA different kind of traumatic ulcer

© Photo: Dr. Carl Kennedy, Montgomery, West Virginia

Differential Dx: Inflammatory Ulcer without Red HaloDifferential Dx: Inflammatory Ulcer without Red HaloCaution! Lack of red halo might indicate immune deficiencyCaution! Lack of red halo might indicate immune deficiency

Diabetic ulcer of hard Diabetic ulcer of hard palate: deep ulcer bed palate: deep ulcer bed

of fat with of fat with saponification (black), saponification (black), without inflammatory without inflammatory

halo and with no halo and with no healing after biopsy healing after biopsy

(see suture).(see suture).


#9 Lesion: Inflammatory Erythema#9 Lesion: Inflammatory ErythemaPrevalence (# Lesions/1,000) = 4.5 for Males, 4.8 for Females, 4.7 TotalPrevalence (# Lesions/1,000) = 4.5 for Males, 4.8 for Females, 4.7 Total


Denture Stomatitis (Allergy to Partial Denture) & Torus PalatinusDenture Stomatitis (Allergy to Partial Denture) & Torus Palatinus

TorusTorus

Differential Dx: Plasma Cell GingivitisDifferential Dx: Plasma Cell GingivitisCaution! Only located on attached alveolar mucosa, facial surface.Caution! Only located on attached alveolar mucosa, facial surface.


Differential Dx: Erythroplakia (Usually Carcinoma in Situ)Differential Dx: Erythroplakia (Usually Carcinoma in Situ)Caution! May look like simple trauma erythema.Caution! May look like simple trauma erythema.


#10 Lesion: Papilloma (Squamous Papilloma)#10 Lesion: Papilloma (Squamous Papilloma)Prevalence (# Lesions/1,000) = 5.3 for Males, 4.2 for Females, 4.6 TotalPrevalence (# Lesions/1,000) = 5.3 for Males, 4.2 for Females, 4.6 Total

© Photos: Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

Differential Dx: Verruca Vulgaris (Common Wart)Differential Dx: Verruca Vulgaris (Common Wart)Caution! Multiple papillary masses of lip in a young person may be contagiousCaution! Multiple papillary masses of lip in a young person may be contagious


Differential Dx: Condyloma Acuminatum (Venereal Wart)Differential Dx: Condyloma Acuminatum (Venereal Wart)Caution! Pink, pebbled papillary lesion may be a contagious venereal wart.Caution! Pink, pebbled papillary lesion may be a contagious venereal wart.


Squamous cell carcinomaSquamous cell carcinoma

#11 Lesion: Epulis Fissuratum#11 Lesion: Epulis FissuratumPrevalence (# Lesions/1,000) = 3.4 for Males, 4.4 for Females, 4.0 TotalPrevalence (# Lesions/1,000) = 3.4 for Males, 4.4 for Females, 4.0 Total

© Photos: Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia;Dr. Robert Bjorkman, Minneapolis, Minnesota

#12 Lesion: Lingual Varicosities#12 Lesion: Lingual VaricositiesPrevalence (# Lesions/1,000) = 3.5 for Males, 3.4 for Females, 3.5 TotalPrevalence (# Lesions/1,000) = 3.5 for Males, 3.4 for Females, 3.5 Total

© Photo: Dr. Ernest Lalonde, West Virginia University, Morgantown, West Virginia.

#13 Lesion: Fissured Tongue#13 Lesion: Fissured TonguePrevalence (# Lesions/1,000) = 3.5 for Males, 3.1 for Females, 3.3 TotalPrevalence (# Lesions/1,000) = 3.5 for Males, 3.1 for Females, 3.3 Total


Note: Hemorrhage on right is from extraction site.Note: Hemorrhage on right is from extraction site.

#14 Lesion: Benign Migratory Glossitis #14 Lesion: Benign Migratory Glossitis Prevalence (# Lesions/1,000) = 3.4 for Males, 3.0 for Females, 3.1 TotalPrevalence (# Lesions/1,000) = 3.4 for Males, 3.0 for Females, 3.1 Total


Differential Dx: Combined Geographic & Fissured TongueDifferential Dx: Combined Geographic & Fissured Tongue

Note: A large proportion of geographic tongues are fissuredNote: A large proportion of geographic tongues are fissured

© Photo: Dr. Julie Staggers, Winchester, Virginia

#15 Lesion: Papillary Hyperplasia of the Palate#15 Lesion: Papillary Hyperplasia of the PalatePrevalence (# Lesions/1,000) = 1.7 for Males, 3.8 for Females, 3.0 TotalPrevalence (# Lesions/1,000) = 1.7 for Males, 3.8 for Females, 3.0 Total


#16 Lesion: Herpes Labialis #16 Lesion: Herpes Labialis Prevalence (# Lesions/1,000) = 2.4 for Males, 2.6 for Females, 2.5 TotalPrevalence (# Lesions/1,000) = 2.4 for Males, 2.6 for Females, 2.5 Total


Differential Dx: Primary Herpes Simplex (HS I)Differential Dx: Primary Herpes Simplex (HS I)

© Photos: Dr. David Johnsen & Dr. Sanford Fenton, West Virginia University, Morgantown, WV

Differential Dx: ImpetigoDifferential Dx: ImpetigoCaution! This bacterial infection may mimic herpes labialisCaution! This bacterial infection may mimic herpes labialis


Differential Dx: Acute Actinic Hypersensitivity ReactionDifferential Dx: Acute Actinic Hypersensitivity ReactionCaution! Sun “poisoning” may last for weeks or monthsCaution! Sun “poisoning” may last for weeks or months


#17 Lesion: Mucocele #17 Lesion: Mucocele Prevalence (# Lesions/1,000) = 1.9 for Males, 2.6 for Females, 2.4 TotalPrevalence (# Lesions/1,000) = 1.9 for Males, 2.6 for Females, 2.4 Total

© Photos Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia; Dr. Thomas Wilcko, Erie, Pennsylvania

#18 Lesion: Scar Tissue#18 Lesion: Scar TissuePrevalence (# Lesions/1,000) = 2.4 for Males, 1.9 for Females, 2.1 TotalPrevalence (# Lesions/1,000) = 2.4 for Males, 1.9 for Females, 2.1 Total

© Photo: Dr. Richard Hart, West Virginia University, Morgantown, West Virginia

#19 Lesion: Angular Cheilosis (Cheilitis) #19 Lesion: Angular Cheilosis (Cheilitis) Prevalence (# Lesions/1,000) = 1.8 for Males, 1.9 for Females, 1.9 TotalPrevalence (# Lesions/1,000) = 1.8 for Males, 1.9 for Females, 1.9 Total


#20 Lesion: Smokeless Tobacco Keratosis#20 Lesion: Smokeless Tobacco KeratosisPrevalence (# Lesions/1,000) = 4.2 for Males, 0.2 for Females, 1.7 TotalPrevalence (# Lesions/1,000) = 4.2 for Males, 0.2 for Females, 1.7 Total

© Photos: Dr. Richard Marshall, Lewisburg, West Virginia; Dr. Ernest Lalonde, West Virginia University, Morgantown, WV; Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, WV; Dr. William Rosenfeld, Charleston, West Virginia

Snuff pouch, lower lipSnuff pouch, lower lip

Also: periodontal abrasionAlso: periodontal abrasion

Also: tooth loss from chewing tobaccoAlso: tooth loss from chewing tobacco

Note: tobacco chewing Note: tobacco chewing was not a popular was not a popular

habit in Minnesota at habit in Minnesota at the time of the the time of the examinationsexaminations

Differential Dx: Crohn’s DiseaseDifferential Dx: Crohn’s DiseaseCaution! Cobblestone regions of granulomas can appear fissured. Caution! Cobblestone regions of granulomas can appear fissured.


#21 Lesion: Hyperplastic Lingual Tonsil#21 Lesion: Hyperplastic Lingual TonsilPrevalence (# Lesions/1,000) = 2.4 for Males, 1.2 for Females, 1.6 TotalPrevalence (# Lesions/1,000) = 2.4 for Males, 1.2 for Females, 1.6 Total

© Photo: Dr. Brad Neville, Medical University of South Carolina, Charleston, South Carolina

Similar Dx: Hyperplastic Pharyngeal TonsilsSimilar Dx: Hyperplastic Pharyngeal Tonsils

© Photo: Dr. Julie Staggers, Winchester, Virginia

Also: Bifid uvulaAlso: Bifid uvula

#22 Lesion: Hematoma/Ecchymosis#22 Lesion: Hematoma/EcchymosisPrevalence (# Lesions/1,000) = 1.9 for Males, 1.3 for Females, 1.5 TotalPrevalence (# Lesions/1,000) = 1.9 for Males, 1.3 for Females, 1.5 Total


Acute trauma from biteAcute trauma from bite Cough (viral) hematomaCough (viral) hematoma

Fellatio trauma/EcchymosisFellatio trauma/EcchymosisPost-anesthetic hematomaPost-anesthetic hematoma

#23 Lesion: Frictional Keratosis (Chronic Cheek Bite) #23 Lesion: Frictional Keratosis (Chronic Cheek Bite) Prevalence (# Lesions/1,000) = 0.7 for Males, 1.4 for Females, 1.1 TotalPrevalence (# Lesions/1,000) = 0.7 for Males, 1.4 for Females, 1.1 Total

© Photos: Dr. Thomas Wilcko, Erie, Pennsylvania; Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

Additional Diagnosis: Frictional Keratosis (“Callus”)Additional Diagnosis: Frictional Keratosis (“Callus”)


From tongue thrust habitFrom tongue thrust habit

From denture edge trauma/rubbingFrom denture edge trauma/rubbing

#24 Lesion: Lichen Planus#24 Lesion: Lichen PlanusPrevalence (# Lesions/1,000) = 1.2 for Males, 1.1 for Females, 1.1 TotalPrevalence (# Lesions/1,000) = 1.2 for Males, 1.1 for Females, 1.1 Total


#25 Lesion: Squamous Cell Carcinoma#25 Lesion: Squamous Cell CarcinomaPrevalence (# Lesions/1,000) = 2.5 for Males, 0.1 for Females, 0.9 TotalPrevalence (# Lesions/1,000) = 2.5 for Males, 0.1 for Females, 0.9 Total


Differential Diagnosis: Metastatic Carcinoma to MouthDifferential Diagnosis: Metastatic Carcinoma to Mouth

Photos: Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia. Reference & ©: Sokalosky, et al. J Oral Maxillofac Surg 1986; 44:825-827

From esophageal carcinomaFrom esophageal carcinoma

#26 Lesion: Alveolar (Buccal) Exostosis#26 Lesion: Alveolar (Buccal) ExostosisPrevalence (# Lesions/1,000) = 0.9 for Males, 0.9 for Females, 0.9 TotalPrevalence (# Lesions/1,000) = 0.9 for Males, 0.9 for Females, 0.9 Total

© Photos: Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia; Dr. Thomas Wilcko, Erie, Pennsylvania

#27 Lesion: Amalgam Tattoo#27 Lesion: Amalgam TattooPrevalence (# Lesions/1,000) = 0.6 for Males, 1.0 for Females, 0.8 TotalPrevalence (# Lesions/1,000) = 0.6 for Males, 1.0 for Females, 0.8 Total

© Photos: Dr. Ernest Lalonde, West Virginia University, Morgantown, West Virginia; Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

#28 Lesion: Median Rhomboid Glossitis#28 Lesion: Median Rhomboid GlossitisPrevalence (# Lesions/1,000) = 0.8 for Males, 0.5 for Females, 0.6 TotalPrevalence (# Lesions/1,000) = 0.8 for Males, 0.5 for Females, 0.6 Total

© Photos: Dr. Robert Gorlin, University of Minnesota, Minneapolis, Minnesota; Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

Below: posterior midline of tongue Below: posterior midline of tongue with median rhomboid glossitis with median rhomboid glossitis

(arrow) and secondary candidiasis (arrow) and secondary candidiasis (white areas); also called “posterior (white areas); also called “posterior

medial atrophic candidiasis”medial atrophic candidiasis”

Differential Dx: Lingual Thyroid (Ectopic Thyroid Gland)Differential Dx: Lingual Thyroid (Ectopic Thyroid Gland)Caution! A mass in the posterior midline might be theCaution! A mass in the posterior midline might be the

only thyroid in the patient’s body.only thyroid in the patient’s body.


#29 Lesion: Hairy Tongue#29 Lesion: Hairy TonguePrevalence (# Lesions/1,000) = 1.2 for Males, 0.3 for Females, 0.6 TotalPrevalence (# Lesions/1,000) = 1.2 for Males, 0.3 for Females, 0.6 Total


Black hairy tongueBlack hairy tongue

White hairy tongueWhite hairy tongue

#30 Lesion: Atrophic Glossitis (Smooth Tongue)#30 Lesion: Atrophic Glossitis (Smooth Tongue)Prevalence (# Lesions/1,000) = 0.6 for Males, 0.5 for Females, 0.6 TotalPrevalence (# Lesions/1,000) = 0.6 for Males, 0.5 for Females, 0.6 Total


Loss of filiform papillae, pallor of dorsum in iron deficiencyLoss of filiform papillae, pallor of dorsum in iron deficiency

#31 Lesion: ;Nicotine Palatinus #31 Lesion: ;Nicotine Palatinus Prevalence (# Lesions/1,000) = 1.2 for Males, 0.2 for Females, 0.6 TotalPrevalence (# Lesions/1,000) = 1.2 for Males, 0.2 for Females, 0.6 Total

© Photo: Dr. William Rosenfeld, Charleston, West Virginia

Inflamed salivary duct openingInflamed salivary duct opening

#32 Lesion: Epidermoid Cyst #32 Lesion: Epidermoid Cyst Prevalence (# Lesions/1,000) = 0.7 for Males, 0.4 for Females, 0.5 TotalPrevalence (# Lesions/1,000) = 0.7 for Males, 0.4 for Females, 0.5 Total


Yellow color is from sloughed keratin in cyst lumenYellow color is from sloughed keratin in cyst lumen

Differential Dx: Lymphoepithelial CystDifferential Dx: Lymphoepithelial CystCaution! This cyst looks similar but remains small; usually on lateral tongue Caution! This cyst looks similar but remains small; usually on lateral tongue


Cyst on right lateral tongue.Cyst on right lateral tongue.

#33 Lesion: Intramucosal Nevus #33 Lesion: Intramucosal Nevus Prevalence (# Lesions/1,000) = 0.1 for Males, 0.7 for Females, 0.5 TotalPrevalence (# Lesions/1,000) = 0.1 for Males, 0.7 for Females, 0.5 Total

© Photo: Dr. Ernest Lalonde, West Virginia University, Morgantown, West Virginia

#34 Lesion: Oral Melanotic Macule#34 Lesion: Oral Melanotic MaculePrevalence (# Lesions/1,000) = 0.5 for Males, 0.3 for Females, 0.4 TotalPrevalence (# Lesions/1,000) = 0.5 for Males, 0.3 for Females, 0.4 Total


Soft palateSoft palate

Differential Dx: Smoker’s Melanosis Differential Dx: Smoker’s Melanosis Caution! May be combined with thin leukoplakia.Caution! May be combined with thin leukoplakia.


Buccal mucosaBuccal mucosa

Differential Dx: Physiologic (Racial) PigmentationDifferential Dx: Physiologic (Racial) Pigmentation


#35 Lesion: Hyperplastic Oral Tonsil #35 Lesion: Hyperplastic Oral Tonsil Prevalence (# Lesions/1,000) = 0.5 for Males, 0.3 for Females, 0.4 TotalPrevalence (# Lesions/1,000) = 0.5 for Males, 0.3 for Females, 0.4 Total


#36 Lesion: Leukoedema#36 Lesion: LeukoedemaPrevalence (# Lesions/1,000) = 0.4 for Males, 0.3 for Females, 0.3 TotalPrevalence (# Lesions/1,000) = 0.4 for Males, 0.3 for Females, 0.3 Total


Entire buccal mucosa is gray/white

#37 Lesion: Herpes Zoster (Shingles) #37 Lesion: Herpes Zoster (Shingles) Prevalence (# Lesions/1,000) = 0.5 for Males, 0.2 for Females, 0.3 TotalPrevalence (# Lesions/1,000) = 0.5 for Males, 0.2 for Females, 0.3 Total


#38 Lesion: Lipoma#38 Lesion: LipomaPrevalence (# Lesions/1,000) = 0.1 for Males, 0.4 for Females, 0.3 TotalPrevalence (# Lesions/1,000) = 0.1 for Males, 0.4 for Females, 0.3 Total

© Photos: Dr. Brad Neville, Medical University of South Carolina, Charleston, South Carolina

#39 Lesion: Pseudomembranous Candidiasis#39 Lesion: Pseudomembranous CandidiasisPrevalence (# Lesions/1,000) = 0.4 for Males, 0.2 for Females, 0.3 TotalPrevalence (# Lesions/1,000) = 0.4 for Males, 0.2 for Females, 0.3 Total


In leukemia patientIn leukemia patient

Under dentureUnder denture

Candida hyphae (GMS silver stain)Candida hyphae (GMS silver stain)

#40 Lesion: Intraoral Secondary Herpes Simplex#40 Lesion: Intraoral Secondary Herpes SimplexPrevalence (# Lesions/1,000) = 0.1 for Males, 0.3 for Females, 0.2 TotalPrevalence (# Lesions/1,000) = 0.1 for Males, 0.3 for Females, 0.2 Total

© Photos: Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia;Dr. William Rosenfeld, Charleston, West Virginia

Vesicles tend to clusterVesicles tend to cluster

Vesicles remain on Vesicles remain on attached mucosaattached mucosa

Differential Dx: Intraoral Type II Herpes Simplex Differential Dx: Intraoral Type II Herpes Simplex Caution! If there is no gingivitis, it might be a STDCaution! If there is no gingivitis, it might be a STD


#41 Lesion: Ranula #41 Lesion: Ranula Prevalence (# Lesions/1,000) = 0.2 for Males, 0.1 for Females, 0.2 TotalPrevalence (# Lesions/1,000) = 0.2 for Males, 0.1 for Females, 0.2 Total

© Left photo: Dr. Jerry Bouquot, The Maxillofacial Center, Morgantown, West Virginia

#42 Lesion: Salivary Stone (Sialolithiasis) #42 Lesion: Salivary Stone (Sialolithiasis) Prevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.1 TotalPrevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.1 Total


Two sialoliths of oral floorTwo sialoliths of oral floor

#43 Lesion: Bifid Uvula #43 Lesion: Bifid Uvula Prevalence (# Lesions/1,000) = 0.4 for Males, 0.0 for Females, 0.0 TotalPrevalence (# Lesions/1,000) = 0.4 for Males, 0.0 for Females, 0.0 Total

© Photos: Dr. Julie Staggers, Winchester, Virginia; Dr. Robert Bjorkman, Minneapolis, Minnesota

#44 Lesion: White Coated Tongue#44 Lesion: White Coated TonguePrevalence (# Lesions/1,000) = 0.4 for Males, 0.0 for Females, 0.1 TotalPrevalence (# Lesions/1,000) = 0.4 for Males, 0.0 for Females, 0.1 Total


Differential Dx: Scarlet Fever Differential Dx: Scarlet Fever (with Strawberry or Raspberry Tongue) (with Strawberry or Raspberry Tongue)

Caution! A heavy white coated tongue might represent a Strep. InfectionCaution! A heavy white coated tongue might represent a Strep. Infection


#45 Lesion: Gingival Fibrous Hyperplasia #45 Lesion: Gingival Fibrous Hyperplasia Prevalence (# Lesions/1,000) = 0.1 for Males, 0.1 for Females, 0.1 TotalPrevalence (# Lesions/1,000) = 0.1 for Males, 0.1 for Females, 0.1 Total

© Photos Dr. Thomas Wilcko, Erie, Pennsylvania

Hereditary gingival fibromatosisHereditary gingival fibromatosis

Dilantin gingivitisDilantin gingivitis

ScurvyScurvy

Differential Dx: Leukemic GingivitisDifferential Dx: Leukemic GingivitisCaution! Erythematous, semi-translucent enlargement may represent Caution! Erythematous, semi-translucent enlargement may represent

gingival accumulation of malignant leukocytes.gingival accumulation of malignant leukocytes.

© Photo: Dr. Robert Gorlin, University of Minnesota, Minneapolis, Minnesota

#46 Lesion: Hyperplastic Buccinator Lymph Node #46 Lesion: Hyperplastic Buccinator Lymph Node Prevalence (# Lesions/1,000) = 0.1 for Males, 0.1 for Females, 0.1 TotalPrevalence (# Lesions/1,000) = 0.1 for Males, 0.1 for Females, 0.1 Total


Buccal MucosaBuccal Mucosa

Similar Dx: Hyperplastic (Inflamed) Submandibular Lymph NodeSimilar Dx: Hyperplastic (Inflamed) Submandibular Lymph Node

© Photos: Dr. Charles Halstead, Virginia

#47 Lesion: Commisural lip Pits #47 Lesion: Commisural lip Pits Prevalence (# Lesions/1,000) = 0.1 for Males, 0.1 for Females, 0.1 TotalPrevalence (# Lesions/1,000) = 0.1 for Males, 0.1 for Females, 0.1 Total


#48 Lesion: Cyst of Blandin-Nuhn#48 Lesion: Cyst of Blandin-Nuhn(Mucocele of Ventral Tongue)(Mucocele of Ventral Tongue)

Prevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.1 TotalPrevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.1 Total


Cyst of Blandin-Nuhn of midline ventral tongue,Cyst of Blandin-Nuhn of midline ventral tongue,with secondary hemorrhagewith secondary hemorrhage

#49 Lesion: Macroglossia #49 Lesion: Macroglossia Prevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.07 TotalPrevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.07 Total

© Left Photo: Dr. Robert Gorlin, University of Minnesota, Minneapolis, Minnesota

ScurvyScurvyAngioedemaAngioedema

#50 Lesion: Pyogenic Granuloma#50 Lesion: Pyogenic GranulomaPrevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.07 TotalPrevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.07 Total


Prevalence rates include only untreated lesions.

Presumably most pyogenic granulomas are surgically

removed early in their development

Pregnancy Tumor Pregnancy Tumor Pyogenic granuloma during pregnancyPyogenic granuloma during pregnancy

© Photo: Dr. Richard Hart, West Virginia University, Morgantown, West Virginia

Differential Dx: Peripheral Ossifying FibromaDifferential Dx: Peripheral Ossifying Fibroma

© Photo: Dr. Skip Gladwin, West Virginia University, Morgantown, West Virginia

#51 Lesion: Nasolabial Cyst #51 Lesion: Nasolabial Cyst Prevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.07 TotalPrevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.07 Total

© Photos: Dr. George Gallagher, Boston University, Boston, Massachusetts

#52 Lesion: Neurofibroma/Schwannoma #52 Lesion: Neurofibroma/Schwannoma Prevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.07 TotalPrevalence (# Lesions/1,000) = 0.0 for Males, 0.1 for Females, 0.07 Total

Photos: Dr. Brad Neville, Medical University of South Carolina, Charleston, South Carolina

#53 Lesion: Basal Cell Carcinoma of Vermilion Border#53 Lesion: Basal Cell Carcinoma of Vermilion Border Prevalence (# Lesions/1,000) = 0.1 for Males, 0.0 for Females, 0.04 TotalPrevalence (# Lesions/1,000) = 0.1 for Males, 0.0 for Females, 0.04 Total


Lower lip, skinLower lip, skin

The Minnesota Oral Disease Prevalence ProjectThe Minnesota Oral Disease Prevalence Project

During the 1960s and 1970s, in an effort to stimulate rural Minnesota dentists to accept a greater role in diagnosing early oral cancer and precancer, the state Department of Health, the University of Minnesota School of Dentistry, and the American Cancer Society organized 17 community oral cancer screenings. Ultimately more than 35,000 adults over 35 years of age were screened by local dentists under the supervision of faculty from the University of Minnesota Department of Oral Pathology. This represented approximately 2/3 of all the adults over 35 years of age in those small communities.

Records from the earliest screenings were not acceptable for research purposes, but those from the last 23,616 individuals examined were acceptable for the determination of prevalence rates (number of lesions per 1,000 persons examined). All diagnoses were confirmed by an oral pathologist.

In 1974, Dr. J. E. Bouquot published his Master’s thesis (University of Minnesota) relating to these records, but journal articles relative to the data were not published until the 1980s (see following slide).

ReferencesReferences

1. Bouquot JE. An epidemiologic evaluation of oral carcinoma, premalignant epithelial dysplasia and nonspecific clinical Keratoses in an Adult Minnesota Population of 23,616. University of Minnesota Graduate School, 1974:1-96.

2. Bouquot JE. Common oral lesions found in a large mass screening. J Am Dent Assoc 1986; 112:50-57.

3. Bouquot JE, Gorlin RJ. Leukoplakia, lichen planus and other oral keratoses in 23,616 white Americans over 35 years of age. Oral Surg Oral Med Oral Pathol 1986; 61:373-381.

4. Bouquot JE, Gundlach KKH. Odd tongues: the prevalence of common tongue lesions in 23,616 white Americans over 35 years of age. Quint Internat 1986; 17:719-730.

5. Bouquot JE, Gundlach KKH. Oral exophytic lesions in 23,616 white Americans over 35 years of age. Oral Surg Oral Med Oral Pathol 1986; 62:284-291.

6. Bouquot JE, Gundlach KKH. Odd lips: the prevalence of common lip lesions in 23,616 white Americans over 35 years of age. Quint Internat 1987; 18:277-284.

7. Bouquot J, Gnepp D. Epidemiology of carcinoma in situ of the upper aerodigestive tract. J Oral Path , 1988; 17:433. (abstract)

8. Bouquot JE. Epidemiology. In: Gnepp DR (ed.). Pathology of the head and neck. Philadelphia: Churchill-Livingstone; 1988: 263-314.

9. Bouquot JE, Crout RJ. Odd gums: The prevalence of common gingival and alveolar lesions in 23,616 white Americans over 35 years of age. Quint Internat 1988; 19:747-753.

The Maxillofacial CenterThe Maxillofacial Centerfor Education and Researchfor Education and Research

5010 Hazard Street, #2, Houston, TX 77098 USAwww.maxillofacialcenter.com

The Father of Oral PathologyThe Father of Oral PathologyThomas Bond Jr, MD, from Baltimore, Maryland, USAThomas Bond Jr, MD, from Baltimore, Maryland, USA

© Photos circa 1860s

J. E. Bouquot & J. E. Bouquot *J. E. Bouquot & J. E. Bouquot *circa 2002circa 2002

* Jerry (left) and James (right)

common oral lesions

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