Erythematous oral lesions: When to treat, when to leave alone

Erythroplakia requires biopsy followed by wide local excision, since about 50% of these lesions represent invasive carcinomas. Geographic tongue and erythema migrans are largely benign; treatment is symptomatic if patients complain of pain. Red lesions caused by hyper-sensitivity to drugs, foods or, most commonly, dental materials (eg, denture adhesives, toothpastes, and mouth rinses) can arise anywhere in the oral cavity. Treatment consists of discontinuing the offending substance; up to 40 mg/d of prednisone can promote healing. Biopsy is not necessary for most vascular erythematous oral lesions, except Kaposi's sarcoma. If vascular lesions are traumatized, surgery or embolization may be needed to control bleeding. Because pyogenic granuloma and peripheral giant cell granuloma can resemble amelanotic melanoma, they require biopsy. Treatment is excision.