Case• 46. Another white patch on the tongue
SUMMARY
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?
History
Complaint
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.
Examination
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 |
 |
| Fig. 46.1 |
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) |
|---|---|
| Trauma |
Chemical burn
Cheek biting
|
| Infection |
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 |
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