Differential Diagnosis: White Lesions

Question 1

What white lesions are due to Hyperorthokeratosis?

Answer 1

• Frictional Keratosis
  
  • An etiologic trauma factor
• Snuff DIpper’s Keratosis
  
  • Microscopically - thick layer of parakeratin

Question 2

What white lesions are due to Acanthosis?

Answer 2

Leukoedema

• Disappears as you stretch the tissue out because it becomes thinner

Question 3

What white lesions are due to Fibrin?

Answer 3

Apthous ulcers

Question 4

What white lesions are due to coagulated epithelium?

Answer 4

Aspirin Burn

• Cauterizes or denatures the epithelial layer
• The protein has now coagulated and become white in color

Question 5

What white lesions are due to an overgrowth surface of organisms?

Answer 5

Candida

• White colonies of fungi that you can see on a PAS stain

Question 6

What white lesions are due to Fibrosis?

Answer 6

Scars

• Healed, depressed scars have less number of blood vessels and this causes them to be white

Question 7

What is the Differential Diagnosis of White Lesions on the Buccal Mucosa? (8)

Answer 7

• Cheek Biting
• Linea Alba
• Leukoedema
• Hereditary Benign Intraepithelial Dyskeratosis (HBID)
• Pachyonychia Congenita
• Pseudomembranous Candidiasis
• Reticular Lichen Planus
• White Sponge Nevus

Question 8

What is the basis for whiteness in Linea Alba?

Answer 8

Hyperkeratosis and Fibrosis

Question 9

What is the basis for whiteness in Cheek Biting?

Answer 9

Hyperparakeratosis

Question 10

What is the basis for whiteness in Reticular Lichen Planus?

Answer 10

Hyperorthokeratosis

Question 11

What is associated with Whickam Striae?

Answer 11

Reticular Lichen Planus

Question 12

What is the basis for whiteness in White Sponge Nevus, HBID, and Pachyonychia Congenita?

Answer 12

Hyperparakeratosis and Acanthosis

• Cheek biting is also due to hyperparakeratosis*
• Ask the pt is anyone in the family has it (hereditary)

Question 13

What white lesion of the buccal mucosa can be rubbed off?

Answer 13

Pseudomembranous Candidiasis (Trush)

Question 14

What is the Differential Diagnosis for a white lesion in the vestibule? (2)

Answer 14

• Snuff Dipper’s Keratosis
• Chemical Cautery/Denatruation - Aspirin Burn

Question 15

What is the Differential Diagnosis for a White Lesion on the Palate?

Answer 15

Nicotine Stomatitis

• Heat of pipe smoking
• Salivary ducts become inflamed - metaplasia
• “Cantelope rind”
• Hyperkeratosis and Acanthosis

Question 16

What is the Differential Diagnosis for a white, bald, atrophic tongue? (3)

Answer 16

• Lichen Planus of dorsal tongue
• Chronic Hyperplastic Candidiasis
• Syphilitic Glossitis
  
  • Rare
  • Will turn into SCC

Question 17

What is the Differential Diagnosis for a white patch on the lateral tongue? (4)

Answer 17

• Lichen Planus
• Hyperkeratosis
• Dysplasia
• Oral Hairy Leukoplakia

Question 18

If a pt presents with a white patch on the lateral tongue and the biopsy shows Koilocytes, what do we expect it to be?

Answer 18

Oral Hairy Leukoplakia

• HIV assoc
• Caused by EBV (herpes group)
• Probs with lots of Candida

Question 19

What is the Differential Diagnosis for a White Patch in the Vestibule? (5)

Answer 19

• Snuff Dipper’s Keratosis
• Sanguinaria Lesion
• Proliferative Verrucous Leukoplakia
• Verrucous Carcinoma
• Aspirin Burns/Chemical Cautery

Question 20

Which white patch of the vestibule will disappear if the pt stops the habit, and which one will not go away?

Answer 20

Snuff Dipper’s Keratosis - within 2 weeks

Sanguinaria Lesions - does not go away