Dentaltown September 2019 - 80
Question
Nine
A 66-year-old female presents for an evaluation of a white lesion on the right side of the
tongue, which was noticed by her hygienist at a
routine dental recall. She is not sure how long
it's been there, and does not experience pain. All
adjacent teeth are smooth. She has never smoked
and occasionally drinks alcoholic beverages (one
glass of wine, once a month). Her medical history is
noncontributory.
Right ventral tongue.
Closer view of the lesion.
Answer: Leukoplakia (clinical, descriptive term),
mild epithelial dysplasia (histopathologic diagnosis).
Leukoplakia is a descriptive term for a white plaque or patch that cannot be
classified clinically or pathologically as any other disease. It is, therefore, a diagnosis of
exclusion; other disorders that cause white lesions-such as frictional keratosis, candidiasis, and lichen planus, drug-induced-must be excluded. Leukoplakic lesions are
considered to be potentially malignant; therefore, a biopsy is necessary to rule out other
causes of keratosis and to assess for the presence of epithelial dysplasia. Leukoplakia
can be characterized as thin or thick; homogenous or nonhomogenous; and granular,
nodular or verrucous.
This particular lesion is a homogenous leukoplakia and was diagnosed as mild
epithelial dysplasia after biopsy. Management depends on the grade of epithelial dysplasia
and overall clinical context. Most mild epithelial dysplasias can be monitored every three
months. Rebiopsy is necessary if the lesion recurs or changes in characteristics. Moderate
and severe epithelial dysplasias should be excised. ■
80
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Dentaltown September 2019
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