Sandbox:Affan

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Muhammad Affan M.D.[2]

Surface oral lesions
Oral lesions			Appearance	Associated conditions	Location	Microscopic	Image
White Lesions		Leukoedema	White or whitish grey edematous lesion Diffuse or patchy	Variant of normal oral mucosa	Buccal and labial oral mucosa	Intracellular edema or vacuolization of Malpighian cells.
		Fordyce granules	White or yellow discrete papules Symmetrically distributed	Variant of normal oral mucosa	Buccal mucosa Vermillion border of the lips	Similar to normal sebaceous glands of skin Lacks hair follicles and almost always lack ductal communication with surface.
		Benign migratoy glossitis	Red patches with white distinct border Map like appearance	Psoriasis Diabetes Reiter's syndrome Medications such as Oral contraceptive pills and lithium carbonate	Dorsal/Lateral surface of the tongue	Acanthosis with neutrophils throughout epithelium and surface Microabscesses, plus inflammatory infiltrate in lamina propria Resembles psoriasis
		Hairy tongue	Elongated filliform lingual papillae Carpet like appearance	Xerostomia Medications such as anti-psychotics HIV Amyotropic lateral sclerosis	Dorsum of the tongue	Marked elongation and hyperparakeratosis of the filiform papillae
		Hairy leukoplakia	White patches Corrugated in appearance Hairy, hair-like growths Permanent	EBV virus infection Immunosupression	Buccal mucosa Lateral surface of the tongue Floor of the mouth Palate	Hyperkeratotic oral mucosa due to piling of keratotic squamous epithelium Cowdry type A intranuclear inclusions Balloon cells with margination of chromatin
		White sponge nevus	White patches of tissue (nevi) Singular or multiple Thickened, velvety, sponge-like appearance	Heriditarary	Buccal mucosa	Parakeratosis, acanthosis Extensive vacuolation Dyskeratotic cells exhibit dense peri and paranuclear eosinophilic condensations Abundant Odland bodies
		Lichen Planus	Reticular or papular lace like white lesions Multiple, Painful	Autoimmune disorders disorders	Posterior buccal mucosa Gingival margin	Hyperkeratosis and acanthosis Granular cell layer, sawtoothing of rete pegs, bandlike chronic inflammatory infiltrate Civatte bodies Artifactual cleft formation No atypia
		Frictional hyperkeratosis	White shaggy plaques Could be easily peeled without any pain leaving normal mucosa	Bite trauma Grinding of the teeth	Buccal mucosa Limited to line of dental occlusion	Hyperkeratinization and acanthosis Smooth, corrugated, or ragged, epthelial surfac with multiple keratin projections
		Leukoplakia	White or grayish in patches that can't be wiped away Irregular or flat-textured Thickened or hardened in areas Along with raised, red lesions (speckled leukoplakia or erythroplakia), which are more likely to show precancerous changes	Smoking	Soft palate Floor of mouth Ventral surface of tongue and the retromolar area	Varies histologically from acanthosis, hyperkeratosis, dysplasia or carcinoma in situ Carcinoma in situ is associated with lymphocytes and macrophages
		Erythroplakia	Fiery red patch Smooth, velvety, granular or nodular lesions	Highest risk of malignant transformation	Soft palate Floor of mouth Ventral surface of tongue and the retromolar area	Thin atrophic epithelium with prominent subepithelial vascularity and inflammation. Almost all erythroplakic lesions contain dysplastic cells
Oral lesions			Characterestic features	Associated conditions	Location	Microscopic	Image
Pigmented lesions	Ephelis		Flat red or light brown spots 3–10 mm in diameter Poorly defined and may merge into large patches	Sun exposed skin	Predominant in outer lips	Mild hyperpigmentation of basal keratinocytes, normal architecture
	Oral melanocytic macule		Focal pigmented brown lesions similar to ephelides Flat and mostly smaller than 1 cm Characterised by a focal increase in melanin production	Idiopathic	Gingiva, with the buccal mucosa and palate	No atypia. Melanin pigmentation tends to be present in significant amounts in the basal-cell layer.
	Oral melanoacanthoma		Rapidly enlarging, asymptomatic, pigmented macule.		Buccal mucosa	Proliferation of benign dendritic melanocytes scattered throughout the epithelium, acanthosis and spongiosis
	Smoker's melanosis		Irregular macular hyperpigmentation of the oral mucosa. Brown patches	Smoking Tobacco chewing	Mandibular anterior gingivain cigarette smokers Buccal mucosa in pipe smokers. Hard palate in those who engage in reverse smoking	Increased melanin pigmentation is noted in the basal cell layer of the epithelium. Melanin incontinence may also be noted in the underlying lamina propria
	Melanoma		Varies from dark brown to blue-black Mucosa-colored and white lesions are occasionally noted Erythema is observed when the lesions are inflamed.	Idiopathic	80% cases involve palate and maxillary gingiva Buccal mucosa, mandibular gingiva, and tongue lesions	Acral lentiginous Malignant cells often nest or cluster in groups in an organoid fashion
	Kaposi sarcoma		Purplish, reddish blue or dark brown macules Plaques and nodules that may ulcerate	HIV and HHV-8.	Hard palate is most frequently affected, followed by the gums	Spindle cells with minimal nuclear atypia
	Addison's disease		Mucosal hyperpigmentation	Autoimmune polyendocrine syndrome Autoimmune hypoparathyroidism resulting in hypocalcemia Vitiligo Premature ovarian failure Pernicious anemia Myasthenia gravis Chronic candidiasis Sjögren syndrome Chronic active hepatitis Diabetes mellitus type 1 Hypothyroidism Hashimoto thyroiditis Graves hyperthyroidism Adrenoleukodystrophy	Gingival Vermillion border of the lips Buccal mucosa, palateand tongue	Hyperparakeratinized areas showing acanthosis, spongiosis, exocytosis, vacuolar degeneration, Substantial deposition of melanin in all epithelial layers Melanocytic hyperplasia Dendritic melanocytes in all epithelial layers.
	Peutz jeghers syndrome		Flat, painless brown pigmented patches	Inherited, autosomal dominant	Perioral Freckling of the skin around lips and vermillionzone of the lips. Intraorally Buccal mucosa Tongue Labial mucosa	Mild acanthosis with elongation of the rete pegs with increased pigmentation in the melanocytes and adjacent keratinocytes
	Neurofibromatosis		Nodular neurofibroma Macroglossia Enlargement of filiform papillae	Cafe au lait macules Freckling in the axillary or inguinalregions (Crowe´s sign) Optic glioma Lisch nodules (irishamartomas) Sphenoid dysplasia A first-degree relative	Tongue Lips Palate Buccal mucosa Gingiva Floor of the mouth or the pharynx	Proliferation of all elements of peripheral nerves Schwann cells with wire like collagen fibrils,fibroblasts and collagen Perineurial cells in plexiform types, mitotic figures are rare
	Polyostotic fibrous dysplasia		Orofacial deformity Dental disorders Bone pains Compromised oral health	McCune-Albright syndrome	Predominantly involves musculo-skeletal defects of oral cavity Gingiva	Curvilinear trabeculae of metaplastic woven bone in hypocellular, fibroblastic stroma
	Medication induced pigmentation
	Amalgam tattoo		Blue-black macules	Dental Implantsurgery	Gingival margin or proximal buccal mucosanear amalgam dental fillings	Pigmented fragments of metal within connective tissue A scattered arrangement of black or dark brown granules Large particles may be surrounded by chronically inflamed fibrous tissue
Oral lesions			Characteristic features	Associated conditions	Location	Microscopic	Image	Image
Vesicular/ Ulcerative	Infections	Herpes simplex virusinfections
	Autoimmune conditions
	Idiopathic conditions

Soft tissue oral lesions
Reactive lesions	Symptoms	Characterstic features	Associated conditions	Location	Image
Leukoedema
Fordyce granules
Hairy tongue
Hairy leukoplakia
White sponge nevus
Lichen planus
Focal keratosis
Tumors		etiology	location	Clinical appearance	Gold standard/Diagnosis	Image
Benign tumors	Epithelial tumors
	Mesenchymal tumors
	Salivary gland tumors
Malignant tumors
Cysts	Gingival cyst
	Lymphoepithelial cyst
	Epidermoid cyst
	Thyroglossal tract cyst
	Nasolabial cyst