White oral lesions: How to distinguish the benign from the deadly

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Chronic irritation from smoking is the most common cause of white mucosal lesions. Because benign leukoplakic growths are virtually impossible to distinguish from carcinoma, biopsy is essential. Obtain a specimen at a nonulcerated area, using a scalpel or biting forceps and an injected or topical anesthetic. Squamous cell carcinoma is generally hyperkeratotic, but it may resemble erythroplakia, be granular, or be ulcerative with a zone of central necrosis. Lichen planus in the oral cavity is usually asymptomatic and requires no treatment, except for the erosive form, which causes pain and burning and warrants prednisone therapy (20 mg/d). Reexamine all patients with lichen planus periodically, since there is risk of transformation to squamous cell carcinoma. Several hereditary syndromes are characterized by white oral lesions; they are generally not precancerous, except for dyskeratosis congenita, which has a strong tendency to malignant transformation. Candidal infection usually presents as a thick white plaque produced by a matted collection of mycelia and desquamated epithelium. Treatment may be local (oral rinsing with nystatin suspension) or systemic (fluconazole, 100 mg/d for 7 to 10 days).

Original languageEnglish
Pages (from-to)301-307
Number of pages7
Issue number4
StatePublished - Apr 2012


  • Darier-White disease
  • Hairy leukoplakia
  • Hyperkeratosis
  • Leukoedema
  • Leukokeratosis
  • Lichen planus
  • Squamous cell carcinoma
  • Stomatitis nicotina
  • Verrucous carcinoma
  • White sponge nevus


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