Recall patient: 68 years old with BP meds and vitamins; generally healthy male. No complaints. He’s been a patient of mine for 14 years. Routine head, neck, and oral soft-tissue screening: “Raise your tongue up, swing it to the right, and touch the inside of your cheek; now to the left…hold on.”
What do my eyes behold? An irregular-bordered leukoplakic lesion on the right posterior lateral base of the tongue. The patient has no pain or knowledge of the lesion’s presence. Palpation is benign to any sort of sensation BUT there is “meat” or depth to the lesion. Interestingly enough, if you look closely, there is a highly vascular area above the superior border, more so than on the anterior and posterior aspects.
Caries were noted on no. 3, and in two weeks, the patient will come back in for restorative work and to reassess this lesion.
Now you know what I know about this situation. Thoughts? Thinking caps on, peeps. THIS is raw and real-time dentistry. If you don’t do thorough exams, you won’t find these lesions. Generally speaking, most oral lesions are self-resolving, but what about those that aren’t? You should be able to list at least three differentials right off the bat; if not, stay tuned for a follow-up in a few weeks along with a refresher.
My gut feeling on this one? Biopsy for a definitive that doesn’t have my Spidey senses feeling all that great. Hopefully I’m wrong.
Keep at it, my friends. More to come soon.
Dr. Stacey
Side note: In case you were wondering, this clinical photo was taken with my iPhone, and yes, it can be done while maintaining patient confidentiality.
More pathology cases
- Pathology case: An almost-vague radiodense lesion
- An extreme case of oral herpes
- Oral pathology case: Venous blue lake mole—what?
- Pathology with an iPhone. Yes, it's really that simple!
Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.
Stacey L. Gividen, DDS, a graduate of Marquette University School of Dentistry, is in private practice in Hamilton, Montana. She is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. Dr. Gividen is the editorial codirector of Through the Loupes and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. She serves on the Dental Economics editorial advisory board. You may contact her at [email protected].
