Persistent, Spreading White Oral Lesions in a Nonsmoker With Seasonal Allergies

Sarah H. Glass, DDS; Michaela Banks


September 22, 2023

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A healthy 59-year-old woman presents to the oral medicine clinic for evaluation of multiple asymptomatic white lesions of the maxillary gingiva. She first noticed the lesions several years ago. Despite multiple biopsies and laser ablation by her oral healthcare providers, the lesions continue to spread.

Additional questioning reveals no traumatic oral habits, no changes in oral hygiene products, no new medications during the onset of the lesions, and no associated extraoral signs or symptoms. She reports no past or current tobacco use or illicit drug use. She drinks 8-10 glasses of wine per week. Her past medical history includes seasonal allergies, for which she takes an over-the-counter antihistamine, and a penicillin allergy.

The results of three previous biopsies from various oral gingival sites show marked hyperkeratosis with mild epithelial dysplasia. Serial clinical images demonstrate that the white oral lesions are enlarging in size and evolving in texture.


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