Evidence-based review and clinical practice recommendations for the diagnosis and management of common oral mucosal lesions

Table 1 Clinical classification of common oral mucosal lesions based on appearance, site, and risk profile

Lesion type	Common sites	Typical appearance	Differential diagnosis	Risk groups	Initial diagnostic approach	Ref.
Leukoplakia	Buccal mucosa, tongue, floor of mouth	White plaque, non-removable, asymptomatic	Frictional keratosis, oral lichen planus, candidiasis	Smokers or tobacco chewing users, the elderly, and alcohol users	Clinical exam + biopsy mandatory to determine the degree of dysplasia	[1,16-18]
Oral lichen planus	Buccal mucosa, gingiva, tongue	White striae (Wickham’s), erythematous, or erosive lesions	Lupus, leukoplakia, lichenoid drug reaction	Middle-aged adults, females > males	Clinical history + biopsy with immunofluorescence	[1,5,27,28,31]
Erythroplakia	Floor of the mouth, soft palate, tongue	Red, velvety lesion, well-demarcated	Inflammation, trauma, erosive lichen planus	Tobacco/alcohol users, the elderly	Urgent biopsy (90% show dysplasia or carcinoma)	[2,6,18,20]
Traumatic ulcer	Anywhere in occlusal or prosthetic trauma zones	Painful ulcer with red halo, irregular margins	Aphthous ulcer, SCC, syphilitic chancre	All age groups, especially denture wearers	History + remove cause; reassess in 2 weeks	[1,13,19,26]
Oral candidiasis, including angular cheilitis	Tongue, palate, buccal mucosa, oral commissures	White patches that can be wiped off, red areas, burning sensation, fissures at the oral commissures (angular cheilitis)	Leukoplakia, lichen planus, geographic tongue	Immunocompromised, denture users, diabetics	Swab for culture; response to antifungals such as nystatin (Nystan®) confirms diagnosis	[1,2,8,24]

SCC: Squamous cell carcinoma.