Differential Diagnosis of Oral and Maxillofacial lesions
1. White lesions of the oral mucosa
2. Solitary oral ulcer and fissures
3. Yellow conditions of the oral
mucosa
王文岑 高雄醫學大學 牙醫學系
高醫大附設醫院S 棟 2 樓 口腔病理影像診斷科
07-3208284; wcwang@kmu.edu.tw
WenChen Wang
White lesions of the oral mucosa
Keratotic Lesions
1. Leukoedema
2. Linea alba buccalis
3. Leukoplakia
4. Nicotinic stomatitis, snuff-dipper’s lesion
5. Benign migratory glossitis and mucositis
6. Lichen planus
7. Papilloma, verrucous vulgaris
8. white exophytic squamous cell carcinoma,
Verrucous carcinoma
9. Hypertrophic candidiasis
10. White sponge nevus
WenChen Wang
Sloughing, pseudomembranous,
necrotic lesions
 Plaque
 Traumatic ulcer
 Pyogenic granuloma
 Chemical burns
 ANUG
 Candidasis
WenChen Wang
Ulcers
Short-term ulcers
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Traumatic ulcers (most)
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Recurrent aphthous ulcers (minor)
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Recurrent intraoral herpes simplex
lesions
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Ulcers as result of odontogenic
infection
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Ulcers with generalized mucositis or
vesiculobullous disease
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Ulcers secondary to systemic disease
WenChen Wang
Persistent ulcers
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Traumatic ulcers (occasional)
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Ulcers from odontogenic infection
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Squamous cell carcinoma
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Chancre
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Gumma
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Ulcer secondary to systemic disease
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Low-grade mucoepidermoid tumor
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Metastatic tumor
WenChen Wang
Normal Color of Oral Mucosa
1). dark pink (reddish) to very pale (almost white).
2). thickness of epithelium, degree of keratinization
A). thicker epithelium: more keratinized, more fibrous and
less vascular subepithelial connective tissue--color is
whiter; hard palate, fixed gingival, dorsal surface of the
tongue.
B). darker pink or more reddish in color: less keratin, more
vascular tissues; vestibule, floor of the mouth, ventral
surface of the tongue, retromolar regions.
C). normal variations pigmentations.
D). substances in the blood, i.e. hemoglobin level
polycythemia (red, cherry red) anemia (pale).
WenChen Wang
Healthy oral
mucosa
WenChen Wang
Healthy oral
mucosa
WenChen Wang
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Leukoedema
non-malignant variation of normal
mucosa.
most often at buccal mucosa, but also
other sites (labial mucosa, soft palate).
most often seen adults > 40 yrs.
clinical features:
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early stage: firmly opalescence;
later stage: definite grayish white cast
with coarsely wrinkle surface which
cannot be removed with a tongue blade,
but will disappear on stretching.
(if injury: red eroded area, mimic cheek
biting).
WenChen Wang
Leukoedema
WenChen Wang
Leukoedema
WenChen Wang
Leukoedema
microscopic findings:
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increased thickness of epithelium.
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marked intracellular edema (ballooning)
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acanthosis: abnormal thickening of the
spinous layer (may be severe with
elongation, thickening, blunting, and
confluence of the rete pegs or may consist
only of their elongation).

parakeratosis: hyperkeratosis with retention
of nuclei.
WenChen Wang
Leukoedema
WenChen Wang
Leukoedema
D.D.
 leukoplakia, cheek-biting
lesion, white sponge nevus.
Treatment:
 no treatment is required
WenChen Wang
Linea alba buccalis
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usually on buccal mucosa near the occlusal
plane.
usually bilateral, may be related with occlusal
trauma, therefore more prominent if patient
has little overjet of molars and premolars.
Microscopic findings:
increased thickness of epithelium, or
hyperorthokeratosis (hyperkeratosis without
retention of nuclei).
Treatment:
no special treatment, to avoid bite injury,
change the relationship of upper and lower
teeth (new denture or orthodontic treatment)
WenChen Wang
Linear alba
WenChen Wang
Leukoplakia
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White patch
keratotic change occurring on mucous
membranes.
usually caused by chronic irritation.
important etiologic factors including:
smoking, cold temperature, hot and/or
spicy foods, alcohol, betel nut and /or
tabacoo chewing, occlusal trauma,
sharp edges of prostheses or teeth,
actinic radiation.
WenChen Wang
Leukoplakia
Clinical features:
asymptomatic, old age group (40–70 yrs).
most happened at: tongue, floor of the mouth,
lower lip, commissures, palate, mucobuccal fold,
alveolar ridge, retromolar area, buccal mucosa.
D.D.
first R/O lesions of sloughing
pseudomembranous types.
easy to scrap off or not? if not, lesions are
keratotic and need to D.D. with many white lesions.
WenChen Wang
Homogeneous thick leukoplakia
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Leukoplakia
WenChen Wang
Speckled leukoplakia
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Non-homogeneous thick leukoplakia
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Verrucous leukoplakia
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Verrucous leukoplakia
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Verrucous leukoplakia
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Hairy leukoplakia
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Special types of Leukoplakia
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Hairy leukoplakia
AIDS patient: irregular surface like hair.
acanthosis with marked hyperparakeratosis
with formation of ridged and keratin
projections, areas of ballooning cells and little
or no inflammation in the connective tissue.
Ballooning changes = koilocytes: enlarged
cells, some with enlarged nuclei with
perinuclear halos, others are pyknotic nuclei.
(papilloma-like virus) ,(EM: EB virus),
(Immunofluorescence staining for EB virus
capsid antigens).
WenChen Wang
毛狀白斑
(Hairy
leukoplakia)
EB病毒感染引起
WenChen Wang
Hairy Leukoplakia on margin
of tongue in a homosexual man
WenChen Wang
Koilocytes: Hairy leukoplakia
WenChen Wang
Lesion due to corroded amalgam
fillings lingually in mandibular molars,
similar with hairy leukoplakia
WenChen Wang
D.D. of hairy leukoplakia in AIDS
1. lesions due to restorative materials:
corroded amalgam fillings, white lesions
will disappear within a few weeks after
fillings are replaced by plastic material.
2. leukoplakia:
a. idiopathic leukoplakia: often
located on tongue (inferior surface),
usually middle-aged women, extensive
and smooth surface.
b. tobacco-associated leukoplakia:
border of tongue, well-defined, smooth
surface, regress after stop smoking.
WenChen Wang
D.D. of hairy leukoplakia in AIDS
3. lichen planus: border of the tongue,
rare (reticular type).
4. chronic hyperplastic candidiasis:
labial commissures extending to the
buccal mucosa, disappear after
fungi-static treatment.
WenChen Wang
White Sponge Nevus
young, usually can be seen before puberty
 wide spread, usually whole oral cavity
 has familial pattern
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WenChen Wang
D.D with lichen planus
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Lichen planus usually involve several
lesions, leukoplakia is more often a
solitary lesion.
may have Wickham’s striae: fine
grayish white lines arranged in a
lace-like pattern
may have skin lesion (leukoplakia :
no skin lesion)
WenChen Wang
Lichen planus
WenChen Wang
Nicotinic stomatitis or
smoker’s palate
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Nicotinic stomatitis or smoker’s
palate, smoker’s keratosis
man, pipe smokers.
usually whole hard palate.
reddish stomatitis changed to slightly
opalescent then white.
usually “red/pink dots/spots” as the
centers of lesion indication
inflammation of minor salivary glands.
usually disappear after stopping pipe
smoking.
WenChen Wang
Stomatitis nicotina palati
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Snuff dipper’s lesion,
Tobacco chewer’s lesion
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parboiled appearance of the white
lesion, some are thick white plaque
lesion depends on where the tobacco
was contact with the mucosa.
usually on the mandibular vestibule
(both the incisors and the molar
regions).
if change the habit, then most lesions
will completely disappear.
WenChen Wang
Tobacco chewer’s lesion
WenChen Wang
Hairy Tongue
WenChen Wang
White hairy tongue
1.elongation of the filiform papillae:
increased retention of keratin.
2.male more than female.
3.depends on foods, the color can be
different.
4.treated by tongue brushing.
WenChen Wang
Black Hairy Tongue
WenChen Wang
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Black hairy
tonguefiliform papillae.
Caused by elongated
Other causes:
(i) antibiotics (penicillin or tetracycline)
(ii) mouthwashes (sodium perborate or
chlorhexidine)
(iii) iron preparations
(iv) smoking
(iv) some foodstuffs
(v) herbs
WenChen Wang
Geographic
Tongue
WenChen Wang
Geographic tongue
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Benign migratory glossitis and mucositis
(Geographic tongue)
1.psychological influences and suspected.
2.irregularly shaped red patches and white
patterns like map, on the dorsal , ventral
and lateral surfaces of tongue.
3.red patches: desquamated filiform
papillae: enlarge and regressive:change
every week then completely disappear.
WenChen Wang
Geographic tongue
4.generally asymptomatic, sometimes
burning sensation, tenderness and
pain.
5. treated with : a. bland diet; b.
coating the lesion with triamcinolone
in Orabase, if symptoms occur
WenChen Wang
Median rhomboid
glossitis
WenChen Wang
Median rhomboid glossitis
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May be congenital ( persistence of the
tuberculum impair) or may be associated
with candidal infection. Smoking may
predispose to the candidosis.
There is:
(i) absence of filiform papillae.
(ii) epithelial hyperplasia and acanthosis.
(iii) chronic inflammatory infiltrate in the
lamina propria.
WenChen Wang
Lichen planus
1. Affecting 0.5-2.0% of the population
2. Mean age at onset: 30-50 years
3. A mild predilection for females
4. Six forms: reticular, papular, plaque,
atrophic, erosive, bullous
5. Malignant transformation -- <1%
6. Etiology: emotional stress or
aberrant cellular immunity
WenChen Wang
Lichen planus
7. sites: mostly at buccal mucosa
(85%), others including gingiva,
tongue, palate, floor of the mouth,
vermillion border, (skin: small flat
papules/ulceration may fuse
together).
WenChen Wang
Reticular lichen planus
(Wickham’s striae)
WenChen Wang
Erosive
lichen planus
WenChen Wang
Plaque type lichen planus
WenChen Wang
Erosive lichen planus
Desquamative gingivitis
WenChen Wang
Lichen planus
WenChen Wang
Bullous Lichen Planus
If severe liquefaction, then bullae formed;
in very severe case, then disseminated
erosions.
WenChen Wang
D.D.1. White sponge nevus
White sponge nevus usually appears at
birth (OLP : 70% after 40 yrs.)
D.D.2. Geographic tongue
Geographic tongue -- red center with a
slightly raised white border: rapidly (in a
few days) change site and shape
OLP , if change, take longer time
WenChen Wang
D.D. 3. Leukoedema
Leukoedema if has wrinkles, stretching test
can be used to D.D. with Wickham’s striae.
D.D. 4. Linea alba
Patient sucking cheeks habit, then
often has linea alba and mimic
Wickham’s striae: asking about
patient’s habit.
WenChen Wang
D.D. 5. Lichenoid reactions
History of taking drugs:
a. systemic treatment with streptomycin,
tetracycline, hypoglycemics, diuretics,
indomethacine….
b. dental restorative materials: dental
gold, mercury, silver alloys.
WenChen Wang
Papules Lichen Planus
WenChen Wang
Management: OLP
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no treatment jf no discomfort,
examined periodically.
clinical discomfort ( i.e.
burning , tenderness, soreness of
oral mucosa): topical steroid
severe cases: systemic
administration of sedative and
cortisone.
WenChen Wang
Squamous cell papilloma,
papilloma
WenChen Wang
Squamous cell papilloma
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Features:
1. exophytic, papillomatous shape,
pedunculated with rough,
cauliflower-like pebbly surface,
deep cleft formation.
2. In oral cavity, usually < 1 cm
3. site: tongue (33%), palate, buccal
mucosa, gingiva, lips,
mandibular ridge, mouth floor
WenChen Wang
Squamous cell papilloma
1. age: most 21-50 yrs (<40yrs)
2. Not usually in oral cavity, 3. malignant
change: very rare (no dysplastic
changes)
4. color (depends on whether chronic
irritation)hyperkeratosis or not 
white or pink.
WenChen Wang
Verrucous hyperplasia
Exophytic mass (a proliferative
epithelial lesion), like papilloma.
 Precancerous lesion
 Epithelial hyperplastic fold towards
mucosa surface.
 If malignant change: towards
underlying connective tissue
 (some scholars believe: VH =CA).
 Betel nut chewing habit in Taiwan

WenChen Wang
Verrucous hyperplasis
WenChen Wang
Verrucous hyperplasis
WenChen Wang
Verrucous hyperplasis
WenChen Wang
Verrucous hyperplasis
WenChen Wang
Verrucous hyperplasis
WenChen Wang
Verrucous hyperplasis
*management:
surgical removal.
microscopic findings:
confined the final
diagnosis.
WenChen Wang
Verrucous carcinoma
1. an exophytic type of low-grade SCC.
2. features:
1). most sites: mandibular labial and
buccal vestibule and mucosa.
2). older ages: average 60-70 yrs.
3). may be very large papillary mass or
flat covered whole mucosa (sessile
base).
4). color depends on the amount of
keratin: pink or white.
5). may be moderately firm, but not so
hard like invasive CA.
WenChen Wang
Verrucous carcinoma
3. Management:
1). wide excision:5-yr survival rates as high
as 75%.
2). followed-up carefully: a tendency for
multifocal tumors to develop after excision.
3). radiation: not very successful due to
low grade tumor, on the contrary, radiation
may induce malignancy.
WenChen Wang
Verrucous Ca.
WenChen Wang
Distinguishing histologic features between VH and V
ca:
 s: VH, sharp varity; b: VH, blunt varity; c: V. ca
WenChen Wang
Verruca vulgaris
1. exophytic growth of the epithelium:
very common lesion of the skin,
rare in the oral cavity. Induced by
HPV.
2. features:
site: skin, vermillion border, rarely
on labial or buccal mucosa or
tongue.
WenChen Wang
Verruca vulgaris (common wart)
WenChen Wang
D.D. with
papilloma and verrucous vulgaris
verrucous vulgaris: usually on skin,
rarely in the oral cavity.
…sessile base vs. pedunculated
(papilloma).
…round eosinophilic bodies in the cells
( in prickle cell layer and granular cell
layer) : viral inclusion bodies( not seen
in papilloma).
WenChen Wang
Squamous cell papilloma
verrucous vulgaris
WenChen Wang
Squamous cell carcinoma
WenChen Wang
Squamous cell carcinoma
WenChen Wang
Oral Candidiasis
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Moniliasis, candidosis
Classification
A. Acute pseudomembranous (Thrush)
B. Acute atrophic (antibiotic sore mouth)
C. Chronic atrophic (denture-associated
stomatitis)
D. Chronic hyperplastic (chronic
mucocutaneous candidosis; candidal
leukoplakia)
WenChen Wang
Chronic candidiasis
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if low grade infection by Candida
albicans:
due to long term irritation: ( i.e.
tobacco smoking) increase
keratin production and retention 
hyperkeratosis, like leukoplakia 
can not be scraped off
WenChen Wang
Chronic Mucocutaneous
Candidiasis
WenChen Wang
Acute pseudomembranus type
candidiasis
WenChen Wang
Acute pseudomembranus type
candidiasis
WenChen Wang
erythematous
cndidiasis
WenChen Wang
Factors predisposing to oral candidiasis
1. Systemic factors: physiologic old age, infancy,
pregnancy
2. Endocrine disorders: diabetes mellitus,
hypothyroidism
3. Nutritional deficiencies: iron, foliate, or vitamin
B12 deficiency
4. Malignancies:
acute leukemia, agranulocytosis,
5. Immune defects, immuosuppression, AIDS,
thymic aplasia, corticosteroids
WenChen Wang
Candida
Albicans
WenChen Wang
Candidiasis
Management:
a. discontinue broad spectrum
antibiotics treatment, use more
selective ones.
b. anti-fungal therapy, ex. nystatin
suspension
c. treatment of primary diseases.
WenChen Wang
AIDS
1. Pseudomembranous cadidiasis,
2. Erythematous candidiasis: lesion on
the tongue: along the mid-line and the
filiform papilla atrophic.
3. If esophageal candidiasis: may be
AIDS.
WenChen Wang
Oral Candidiasis as the first manifestation of HIV
Infection
WenChen Wang
Submucous fibrosis
1. a fibroelastic change of the lamina
propria.
2. epithelial atrophy: stiffness of the
oral mucosa: trismus and inability to
eat.
3. etiology: unclear, strong irritating
foods and vitamin B def., protein
def., betel nut chewing.
Precancerous condition
WenChen Wang
Submucous fibrosis
1.Clinical:
1). burning sensation: vesicles,
ulcerations or recurrent stomatitis.
2). stiffening of certain areas: difficult
to opening the mouth and swallowing.
3). like systemic sclerosis or
scleroderma.
4). mucosa: finally became blanched and
opaque, fibrotic bands.
5). age: usually 20-40 yrs.
WenChen Wang
Submucous fibrosis
WenChen Wang
Submucous fibrosis
WenChen Wang
Submucous fibrosis
WenChen Wang
Submucous fibrosis
WenChen Wang
Submucous fibrosis
2. Microscopic findings:
severe atrophic, rete
pegs disappeared,
epithelial atypia,
disappearance of
fibroblasts, blood
vessels obstructed
or narrowed.
3. Dense collagen
bundles aggregation
WenChen Wang
Submucous fibrosis
3. Treatment:
1).could be precancerous.
2).systemic corticosteroid
and local hydrocortisone
to alleviate pain.
WenChen Wang
Sloughing Pseudomembranous
Necrotic Lesions
May be scraped off the mucosa
with a tongue blade, leaving a
raw bleeding surface.
WenChen Wang
Plaque
Plaque (material alba):
*dental plaque is on the
tooth surface, not easily
been washed off with water.
WenChen Wang
Chemical burns
Chemical burns:
1. some analgesics put in the oral cavity:
mucosal lesions: aspirin burn etc. or
causatic agents (phenol, silver nitrate)
used by dentist.
2. diagnosis: history.
3. treatment: protective coating: Orabase,
bland diet; systemic analgesics.
WenChen Wang
chemical burn
WenChen Wang
chemical burn
WenChen Wang
chemical burn
WenChen Wang
ANUG
Acute Necrotizing Ulcerative Gingivitis
(ANUG, Vincent’s infection, Trench mouth)
1.inflammatory disorder of gingiva, necrotic
ulcerative destruction of the free gingiva,
crest and inter-dental papillae.
WenChen Wang
ANUG
WenChen Wang
ANUG
2. Predisposing factors are very important:
(i). mainly due to decrease resistance to
infection
(ii).gingivitis and periodontitis: poor oral
hygiene
(iii). Stress
these lead to overgrowth of the normal
flora or superinfection by anaerobic and
fusiform bacilli
and spirochete (should be P.i.).
WenChen Wang
ANUG
Differential diagnosis:
1.punched out defects of the interdental papillae: pathognomic for
ANUG.
2.diffuse gangrenous stomatitis:
necrotic gangrenous process spread
to oral mucosa except interdental
papillae and marginal gingiva:
systemic disorders??
WenChen Wang
ANUG
Management:
1.mainly aimed to : superinfection
by anaerobic fusiform and
spirochetes, poor oral hygiene
(gingivitis and periodontitis), and low
resistance to infection.
WenChen Wang
ANUG
(i). antibiotics (penicillin 500mg, q.i.d.
>5days).
(ii). careful scaling, curettement and
debridment ( best 24-48 hrs after
antibiotics treatment).
(iii). oral rinsing with a solution of 3% H2O2
in saline (1:3), 12x daily.
(iv). recontouring of the gingiva if
necessary.
WenChen Wang
Candidiasis
WenChen Wang
Angular cheilitis
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Predisposing factors: decreased
vertical dimension of dentures,
anemia, vitamin B deficiencies
Infection with Candida albicans,
other microorganisms
Treatment: eliminate predisposing
factors, antifungal ointment
(nystatin)
WenChen Wang
Angular cheilitis
WenChen Wang
Angular cheilitis
WenChen Wang
Yellow Lesions
Fordyce’s granules:
a collection of sebaceous
glands, covered by normal
mucosa.
clinically: small elevated
granules, color from whitish
yellow to yellow.
WenChen Wang
Fordyce’s granules
1. in oral cavity: buccal mucosa
(usually bilateral), retromolar pad,
labial mucosa.
2. usually no ulceration, looks like
cheese.
3. histological features: like normal
sebaceous glands of skin.
4. 50-80% population may have, a
benign lesions, patient cancer
phobia.
WenChen Wang
Fordyce’s granule
WenChen Wang
Fordyce’s granule
WenChen Wang
Lipoma
1. the most common benign
neoplasms, but rarely in oral
cavity.
2. mature fat cells under skin
tissue.
3. usually after 40 yrs., peak at
50 yrs (middle age).
WenChen Wang
Lipoma
4. in oral cavity: most on buccal
mucosa and mucobuccal fold, then
tongue, floor of the mouth and lips.
5. usually yellow color, but many
shapes: sessile, pedunculated;
usually smooth surface, no-ulcerated
(except with trauma).
6. palpation: nontender, soft, felling like
cheese.
7. usually single lesion.
WenChen Wang
Lipoma
WenChen Wang
Lipoma
1. Microscopic findings: mature fat cells
within a connective tissue capsule,
fibrous stroma divided into lobules,
blood vessels in the septa.
2. Treatment: excision for large lesion, no
treatment for small lesions.
WenChen Wang
Epidermoid and Dermoid Cysts
1. a kinds of developmental anomalies.
Cystic teratoma comes from germinal
epithelium.
2. any place in the body, not usually in
the oral cavity.
3. if in the oral cavity: patient may have
swelling of his/her floor of the mouth.
4. at head and neck: most at floor of the
mouth, then at submaxillary and
submental areas.
WenChen Wang
Epidermoid and Dermoid Cysts
5. any ages, but mostly discovered in 1535 yrs. old, nontender, various sizes,
non-fixed, if no trauma: smooth surface.
6. histology classification depends on
cystic contents:
(i). epidermoid cyst: fluid, keratin, nonspecific structures.
(ii). dermoid cyst: sebaceous materials,
keratin.
(iii). Teratoma: many elements from
different germinal layers: bone,
muscle, teeth etc.
WenChen Wang
Epidermoid cysts
Dermoid Cysts
WenChen Wang
Epidermoid and Dermoid Cysts
Differential diagnosis:
ranula, thyroglossal duct cyst, cystic
hygroma, brachial cleft cyst, cellulitis,
tumors, fat masses.
Thyroglossal duct cyst
WenChen Wang
Oral Ulcers and Fissures
Recurrent aphthous ulcer (canker sore)
(RAU) and Intraoral recurrent ulcer of
herpes simplex (IRHS)
Both are:
(i). easy recurrent painful ulcer (superficial),
each time lasts 1-2 wks;
(ii). usually have tender LAP
(iii). spontaneous heal, no sequelae (scar
formation).
WenChen Wang
RAU and IRHS
Differences:
(i). Etiology:
RAU: psychic, allergic, microbial, traumatic,
endocrine, hereditary and autoimmune
mechanisms.
IRHS: HSV infection, may be subclinical
infection, virus became latent in nerve
endings or ganglions reactivation 
epithelial cells lesions.
WenChen Wang
RAU and IRHS
(ii). Sites:
RAU: freely movable mucosa (nonkeratinized): lips, buccal mucosa,
tongue, mucobuccal fold, floor of the
mouth, soft palate.
IRHS: fixed mucosa (keratinized): hard
palate, gingiva and alveolar ridge.
WenChen Wang
RAU and IRHS
3. Management:
a. in general, no treatment, heal after 1-2
weeks;
b. some ones used:
RAU: tetracycline mouthwash and cortisone
in Orabase; analgesics (may be).
IRHS: Vira-A or Zovirax cream (Acyclovir)
WenChen Wang
Minor type of Recurrent aphthous ulcer
WenChen Wang
Major recurrent aphthous ulcer
WenChen Wang
Herpetiform recurrent aphthous ulcer
WenChen Wang
Primary herpetic gingivostomatitis
WenChen Wang
Recurrent herpes labialis
WenChen Wang
Herpetiform recurrent aphthous ulcer
WenChen Wang
Tuberculosis (TB)
1. infectious organisms: Mycobacterium
tuberculosis.
2. at oral cavity: uncommon, if any, rarely are
primary lesion,
but secondary to pulmonary lesions.
3. pulmonary lesion: sputum to small injury site
of mucosa tissue, or through hematogenous
spread to submucosa then proliferation to
ulceration.
4. mostly at tongue then palate, lips, buccal
mucosa, gingiva, frenula.
WenChen Wang
TB
5. irregular, painful ulcer, became larger
slowly
6. easily to have trauma then can be
mistaken as traumatic ulcer or
carcinoma
7. sometimes without ulcer; if on gingival,
then diffuse, hyperemic, nodular or
papillary proliferation
8. sometimes involved bone (maxilla or
mandible) through hematogenous
spread.
WenChen Wang
Tubercurosis
WenChen Wang

Tubercles of epitheloid cells, Langhan’s giant cells,
mononuclear cells in periphery
WenChen Wang
Differential Diagnosis of Ulcers
Ulcers secondary to systemic disease
1. History of predisposing disease or
history revealing information
suggesting presence of disease.
2. Example: Steven-Johnson syndrome
(Erythema multiform).
WenChen Wang
Erythema multiform
1. involves lips with multiple red
lesions (papule or bullae): rupture:
raw, painful lesions
2. other sites including skin lesions;
before disease, may have HSV, taken
drugs (antibiotics, contraceptives,
barbiturates), post-radiation therapy
( i.e. ulcerative colitis patient).
WenChen Wang
Ulcers from odontogenic infections
Ulcers from odontogenic infections:
1. suspicion of ulcer on alveolar or
palate
2. digital pressure on alveolus or tooth
elicits pus from ulcer
3. trace sinus with gutta percha cone:
x-rays to isolate involved teeth.
WenChen Wang
RAU
Recurrent aphthous ulcer:
1. yellowish ulcer, 0.5-2 cm diameter,
with narrow erythematous halo
2. on loose mucosa surface.
IRHS
Intraoral recurrent herpes simplex:
1. cluster of small punctuate ulcers
(< 0.5cm)
2. on bound mucosa.
WenChen Wang
Traumatic ulcers
History of trauma or
presence of potential
etiologic agent.
WenChen Wang
Squamous cell carcinoma
1. high suspicion if patient is male over
40, heavy drinker or smoker
2. no evidence of trauma or systemic
disease; negative serologic findings
3. risk factors involved: alcohol, betel
quid chewing, smoking
WenChen Wang
Squamous cell carcinoma
WenChen Wang
Squamous cell carcinoma
WenChen Wang
民國九十七年台灣地區十大癌症死因
死亡原因
1
2
3
4
5
6
7
8
9
10
每十萬人口
死亡率
肺癌
33.8
肝癌
33.3
結腸直腸癌 18.5
女性乳癌
13.5
胃癌
10.0
口腔癌
9.6
攝護腺癌
7.7
子宮頸癌
6.2
食道癌
6.2
胰臟癌
5.9
死亡人數
7,771
7,651
4,266
1,541
2,292
2,218
892
710
1,433
1,364
98.6.17公佈
台灣地區民國97年有38913人死於癌症，
平均每13分半就有1人死於癌症 WenChen Wang
民國九十七年男性與女性十
大癌症死因
男性
1 肝癌
1
2 肺癌
2
3 結腸直腸癌
3
4 口腔癌
4
5 胃癌
5
6 食道癌
6
7 攝護腺癌
7
8 胰臟癌
8
9 鼻咽癌
9
10非何杰金淋巴癌 10
女性
肺癌
肝癌
結腸直腸癌
女性乳癌
胃癌
子宮頸癌
胰臟癌
卵巢癌
白血病
非何杰金淋巴癌
口腔癌男性死亡2,079人
98.6.17公佈
WenChen Wang
台灣口腔癌死亡人數統計
2500
2312
2000
1500
1860
1723
1560
1436
1993
1838
2041
2202
2044
2152
2218
2079
1874
1613
1501
1000
死亡人數
500
男性死亡人數
0
90年
91年
資料來源:行政院衛生署
92年
製圖：王文岑
93年
94年
95年
96年
97年
WenChen Wang