The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
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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Cite this: Sarah H. Glass, Michaela Banks. Persistent, Spreading White Oral Lesions in a Nonsmoker With Seasonal Allergies - Medscape - Sep 22, 2023.