Case• 46. Another white patch on the tongue

Case46. Another white patch on the tongue


A 39-year-old woman has a white patch on the lateral margin of her tongue. What is the cause and what are the treatment options?



The patient has no symptoms.

History of complaint

The patient is an infrequent dental attender and has not been to the dentist for at least 5 years. Following an oral cancer awareness week she inspected her mouth and became nervous about her tongue. She would like it checked.

Medical history

She has had cervical dysplasia treated in the previous year by cone biopsy and this has left her very worried about cancer. She is otherwise fit and well.
She has smoked 40 cigarettes daily since the age of 18 years and drinks 14 units of alcohol per week as wine.


Extraoral examination

She seems a healthy woman with no obvious skin, nail or eye lesions present on visible skin. No lymph nodes are palpable in the neck.

Intraoral examination

The oral mucosa appears normal, except for the tongue which is shown in Figure 46.1.

Describe the appearance of the tongue lesion.

Site Right lateral border of tongue
Size 1 × 3 cm approximately
Shape III defined ellipse
Colour Mixture of white and red components
Surface Appears nodular or irregular
Palpation reveals the lesion to be firmer than the adjacent mucosa. The white component of the area cannot be rubbed away. The tongue is freely mobile.

Differential diagnosis

What are the causes of mixed red and white patches in the mouth?
The causes of white patches are discussed more fully in Case 45. Several may also be associated with red areas.

Cause Red and white lesion(s)
Chemical burn
Cheek biting
Thrush (acute hyperplastic candidosis)
Chronic hyperplastic candidosis (candidal ‘leukoplakia’)
Lichen planus and similar conditions
Lichen planus
Lichenoid reaction (topical and systemic)
Lupus erythematosus
Idiopathic or smoking
Idiopathic keratosis (leukoplakia) including:

Sublingual keratosis
Smoker’s keratosis
Speckled leukoplakia
Stomatitis nicotina (smoker’s palate)
Neoplasia Squamous cell carcinoma
Which of the above lesions would you include in the differential d/>

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Jan 9, 2015 | Posted by in Oral and Maxillofacial Pathology | Comments Off on Case• 46. Another white patch on the tongue
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