Sandbox leucocytosis

Oral lesion	Differentiating feature	Location	Associated condition
White lesions
Benign migratory glossitis	Red patches with white distinct border Map like appearance	Dorsal/Lateral surface of the tongue	Psoriasis Diabetes Reiter's syndrome Medications such as oral contraceptive pills and lithium carbonate Pregnancy
Hairy tongue	Elongated filiform lingual papillae Carpet-like appearance	Dorsum of the tongue. 25152586	Xerostomia
Leukoedema	White or whitish-gray edematous lesion Diffuse or patchy	Buccal and labial oral mucosa7406518
White sponge nevus	White patches of tissue (nevi) Singular or multiple Thickened, velvety, sponge-like appearance	The moist lining of the oral mucosa buccal mucosa23230487
Hairy leukoplakia	White patches Corrugated in appearance Hairy, hair-like growths Permanent	Lateral portions of the tongue Floor of the mouth Palate Buccal mucosa	EBV virus infection Immunosupression
Oral lichen planus	Lace-like, white patches Erossios	Posterior buccal mucosa Gingival margin
Nicotinic stomatitis	Reddened area and slowly progresses to a white, thickened, and fissured White cobblestone appearance Red dot in the center Cannot be wiped off Painful	Palatal mucosa Posterior hard palate	Smokers
Oral frictional hyperkeratosis	White shaggy plaques Could be easily peeled without any pain leaving normal mucosa	Bilateral buccal mucosa Limited to the line of dental occlusion
Fordyce granules	White to yellow discrete papules, 1 to 2 mm	Symmetrically distributed Buccal mucosa Vermilion border of the lips
Malignant
Epithelial dysplasia
Carcinoma in-situ
Squamous cell carcinoma

Pigmented lesions
Oral lesion		Differentiating feature	Location	Associated Condition
Physiologic		Multifocal, symmetric, persistent and race inherited. Dark-brown band	Marginal gingiva
Intravascular	Hemangioma	Red or bluish-red, slightly raised lesion Rapidly during infancy and regress slowly during childhood	Lip Dorsum of the tongue Gingiva Buccal mucosa	Rendu-Osler-Weber syndrome Sturge-Weber-Dimitri syndrome Kasabach-Merritt syndrome Maffucci syndrome Klippel-Trenaunay-Weber syndrome PHACE(S)
	Kaposi sarcoma	Predominantly skin lesions Oral/ mucosal lesions are less common	Skin
Extra-vascular	Hematoma
	Ecchymosis	Non-palpable purpuric spots	Palate Tongue Lips	Aging Chronic usage of Nonsteroidal anti-inflammatory drugs (NSAIDs) Corticosteroids Anticoagulants Deficiency of zinc Liver disorders
	Petechiae
Melanocytic	Oral melanocytic macule	Focal pigmented brown lesions similar to epheledes Flat and mostly smaller than 1 cm Characterised by a focal increase in melanin production	Vermilion of the lips
	Melanoma
	Ephelis
Diffuse
Addison's disease		Mucosal hyperpigmentatation	Brown patches of Gingival Vermillion border of the lips Buccal mucosa, palate and tongue
Peutz-Jeghers syndrome
Neurofibromatosis		Nodular neuro-fibromas Macrogloassia Enlargement of filiform pappillae	Tongue Lips Palate Buccal mucosa Gingiva Floor of the mouth or the pharynx	Other manifestations Cafe au lait macules Freckling in the axillary or inguinal regions (Crowe´s sign) Optic glioma Lisch nodules (iris harmartomas) Sphenoid dysplasia A first-degree relative
Polyostotic fibrous dysplasia
Smoker's melanosis		Irregular macular hyperpigmentation of the oral mucosa. Brown patches	Mandibular anterior gingiva in cigarette smokers Buccal mucosa in pipe smokers. Hard palate in those who engage in reverse smoking	Smoking

Vesicular/Ulcerative/Erythematous lesions
Oral lesion			Differentiating feature	Location	Associated Condition
Hereditary	Epidermolysis bullosa	Epidermolysis bullosa simplex	Autosomal dominant Intradermal blistering Skin lesions usually disappear without scarring		Pyloric atresia Other congenital abnormalities of the gastrointestinal and genitourinary tract
		Junctional epidermolysis bullosa	Autsomal recessive Separation of lamina lucida at the dermo-epidermal junction Involvement of oral mucosa, Alopecia and annonychia are frequent
		Dystrophic epidermolysis bullosa	Autosomal dominant or recessive Defective anchoring fibrils resulting in separation of sub-basal lamina Blisters results in dystrophic lesions Millium formation due to damaged hair follicles
Infections	Herpes simplex virus infections
	Herpes zoster
	Varicella zoster
	Hand foot mouth disease
	Herpangina
	Infectious mononuceliosis
	Erosive lichen planus
	Mucus membrane pemphigoid
	Candidiosis
Autoimmune	Pemphigus vulgaris
	Bullous pemphigoid
	Lupus erythmatosus
	Aphthous ulcer
	Erythema multiforme
Idiopathic	Erythroplakia
	Contact stomatitis
	Medication induced stomatitis

Surface Lesions of Oral Mucosa				Description		Location	Associated conditions	Image
White lesions
White	Epithelial	Geographic tongue/Benign migratory glossitis		Unknown etiology Mostly asymptomatic but rarely burning sensation Decreased papillae Red patches with white distinct border giving it a map like appearance Diagnosis is clinical but a biopsy may be indicated No treatment for asymptomatic cnditions Anesthetics/antihistamines/Steroids for pain		Dorsal/Lateral surface of the tongue	Psoriasis Diabetes Reiter's syndrome Down's syndrome Pregnancy Medicine such as Oral contraceptive pills, lithium carbonate Asthma
		Hairy tongue		Elongated filiform lingual papillae Carpet-like appearance		Dorsum of the tongue. 25152586
		Leukoedema
		White sponge nevus
		Hairy leukoplakia
		Lichen planus
		Nicotinic stomatitis
		Hyperkeratosis
		Epithelial dysplasia
		Carcinoma in-situ
		Squamous cell carcinoma
	Surface debris	Candidiosis
		Burn
	Subepithelial	Congenital keratotic cyst
		Scar
		Fordyce granules
Pigmented	Localized	Intravascular	Hemangioma
			Varix
			Kaposi sarcoma
		Extravasated blood	Hematoma
			Ecchymosis
			Petechiae
		Melanocytic	Oral melanocytic macule
			Nevus
			Melanoma
			Ephelis
	Diffuse	Hereditary
		Addison's disease
		Heavy metal ingestion
		Peutz-Jeghers syndrome
		Neurofibromatosis
		Polyostotic fibrous dysplasia
		Pregnancy
		Medication
		Smoker's melanosis
Vesicular/Ulcerative/Erythematous
	Hereditary	Epidermolysis bullosa
	Viral	Herpes simplex
		Herpangina
		Hand foot and mouth disease
		Herpes zoster
		Infectious mononucleosis
		Varicella
	Autoimmune	Erosive lichen planus
		Mucous memrane pemphigoid
		Pemphigous vulgaris
		Bullous pemphigoid
		Lupus erythmatosus
	Idiopathic	Aphthous ulcer
		Erythema multiforme
		Erythroplakia
		Medication induced mucositis
		Contact stomatitis
	Mycotic	Candidiosis
Soft Tissue Lesion				Description	Location	Asssociated conditions	Treatment	Image
Tumor/Neoplasms	Benign	Epithelial	Papilloma
			Verruca vulgaris
			Condyloma acuminatum
		Mesenchymal	Fibroma
			Peripheral ossifying fibroma
			Leiomyoma
			Rhabdomyoma
			Peripheral giant cell granuloma
			Hemangioma
			Lymphangioma
			Pyogenic granuloma
			Lipoma
			Neuroma
			Neurofibroma
			Schwannoma
			Granular cell tumor
			Congenital epulis
		Salivary gland	Pleomorphic adenoma
			Papillary cystadenoma lymphomatosum
			Adenoid cystic carcinoma
			Acinic cell adenocarcinoma
			Mucoepidermoid carcinoma low grade
			Polymorphous low grade adenocarcinoma
			Acinic cell adenocarcinoma
	Cyst	Gingival cyst of adult
		Lymphoepithelial cyst
		Epidermoid/dermoid cyst
		Thyroglossal tract cyst
	Malignant	Squamous cell carcinoma
		Verrucous carcinoma
		Lymphoma
		Melanoma
		Sarcoma
		Salivary gland adenocarcinoma	Adenoid cystic carcinoma
			Mucoepidermoid carcinoma
			Polymorphous low grade adenocarcinoma
			Acinic cell adenocarcinoma
		Metastatic carcinoma
Reactive	Sinus track
	Periodontal abscess
	Mucocele
	Fibrous hyperplasia
	Inflammatory papillary hyperplasia
	Necrotizing sialometaplasia

Type of cancer	Subtype	Epidemiology	Localization	Clinical features	Diagnostic procedures
Squamous cell carcinoma Basaloid squamous cell carcinoma Papillary squamous cell carcinoma Spindle cell carcinoma Acantholytic squamous cell carcinoma Adenosquamous carcinoma	Verrucous carcinoma	Older males 5th and 6th decades of life Males are affected more often than females	Lip SCC arise almost exclusively on the lower lip Buccal mucosa Upper and lower gingiva Hard palate Anterior two-thirds of the tongue, including dorsal, ventral and lateral surfaces, and the floor of mouth	Often asymptomatic or may present with vague symptoms and minimal physical finding	Biopsy shows: Thickened club-shaped papillae and blunt stromal invaginations of well-differentiated squamous epithelium with marked keratinization
Lymphoepithelial carcinoma		0.8-2% of all oral or oropharyngeal cancers	Tonsil and tongue(90%) Palate and buccal mucosa(others)	Intraoral mass, which may be ulcerated. Some tumors can be bilateral	Biopsy chows: Syncytial sheets and clusters of carcinoma cells with vesicular nuclei Prominent nucleoli and ill-defined cell borders A rich lymphoplasmacytic infiltrate is present
Epithelial precursor lesions	---	---	Seen in the entire digestive tract	White patches (leukoplakia) Red patches (erythroplasia/erythroplakia) Mixed red and white lesions	Biopsy shows: Hyperplasia Dysplasia, / squamous intraepithelial neoplasia / atypical hyperplasia Carcinoma in-situ
Proliferative verrucous leukoplakia and precancerous conditions	---	Average age at diagnosis is 62 years Women are more commonly afflicted (ratio, 4:1)	Buccal mucosa in women Tongue in men.	An aggressive form of oral leukoplakia with considerable morbidity and strong predilection to malignant transformation	Biopsy shows: Extensive, thick, white plaques Hyperplasia and dense hyperkeratosis Verrucous surface with hyperkeratosis, hypergranulosis and a dense inflammatory infiltrate in the corium
Papillomas	Squamous cell papilloma and verruca vulgaris	Common in children and in adults in the 3rd to 5th decades Almost equal sex incidence with a slight male predominance	Any oral site may be affected mostly: Hard and soft palate Labial mucosa Tongue Gingiva	Soft, pedunculated lesions formed by a cluster of finger-like fronds or a sessile, dome-shaped lesion with a nodular, papillary or verrucous surface	Biopsy shows: Exophytic and comprise folds of hyperplastic stratified epithelium Cluster of finger-like projections
	Condyloma acuminatum	2nd and 5th decade with a peak in teenagers and young adults	Labial mucosa Tongue Palate	Painless, rounded, dome-shaped exophytic nodules 15 mm in diameter Have a broad base and a nodular or mulberry-like surface that is slightly red, pink or of normal mucosal color. Lesions may be multiple and are then usually clustered	Biopsy shows: Several sessile, cauliflower-like swellings forming a cluster
	Focal epithelial hyperplasia	Disease of children, adolescents and young adults	All areas of the oral cavity Labia Buccal mucosa Tongue	Multiple asymptomatic lesions Soft rounded or flat plaque-like sessile swelling. Usually pink or white in color 2-10mm in diameter	Biopsy shows: Rounded sessile swelling formed by a sharply demarcated zone of epithelial acanthosis Koilocytes similar to those of squamous papilloma are usually present “Mitosoid bodies”, which are nuclei with coarse clumped heterochromatin resembling a mitotic figure
Granular cell tumor	---	Arise in all age groups, with a peak between 40 and 60 years Females are affected more often than males with an M/F ratio of 2:1	Tongue is the most common single site Buccal mucosa Floor of oral cavity Palate Salivary gland	Lesion presents as a smooth, sessile mucosal swelling 1-2 cm in diameter with a firm texture. The overlying epithelium is of normal color or may be slightly pale	Biopsy shows: Plump eosinophilic cells with central small dark nuclei and abundant granular cytoplasm
Keratoacanthoma	---	Occurs more often in whites Twice as frequent in men as in women	Skin of the face,including the lips Mucocutaneous linings may also be involved	Verrucous, speckled or ulcerated lesions Deep projections, which extend through minor salivary glands and underlying bone	Biopsy shows: Verrucous surface, keratinized clefts and penetrating squamous rete processes Minimal atypia seen
Papillary hyperplasia	---	Affects all age groups	Palate	Asymptomatic nodular or papillary mucosal lesion	Biopsy shows: Parakeratinisation or less frequently orthokeratinisation
Median rhomboid glossitis	---	---	Dorsum of the tongue at the junction of the anterior two thirds and posterior third	Forms a patch of papillary atrophy in the region of the embryological foramen caecum	Biopsy shows: Psoriasiform hyperplasia Areas of pseudoepitheliomatous hyperplasia Atypia may be present
Salivary gland tumors	Acinic cell carcinoma	2-6.5% of all intraoral salivary gland tumors Age range from 11-77 years, with a mean of 45 years Male to female ratio of 1.5:1	Buccal mucosa Upper lip and Palate	Tumors usually form non-descript swellings	Biopsy shows: Solid sheets of epithelium with secretory material Ductal differentiation in tumors
	Mucoepidermoid carcinoma	9.5-23% of all minor gland tumors	Palate (most common site) Buccal mucosa Lips: upper>lower Floor of oral cavity Retromolar pad	Asymptomatic Bluish, domed swellings that resemble mucoceles or haemangiomas High-grade tumors result in ulceration, loosening of teeth, paraesthesia or anaesthesia	Low power microscopy shows low-grade tumor with both cystic and solid areas and an inflamed, fibrous stroma
	Adenoid cystic carcinoma	42.5% of minor gland tumors	Tongue Tonsil Oropharynx Cheek Lips Retromolar pad and gingiva	Slow growing submucosal masses and ulceration may be seen, particularly in the palate Pain, or evidence of nerve involvement, is usually only present in advanced tumors	Predominantly solid variant shows peri- and intraneural invasion
	Epithelial-myoepithelial carcinoma	---	---	---	---
	Clear cell carcinoma, NOS		---	---	---
	Basal cell adenocarcinoma	Rare in minor glands	Palate Buccal mucosa Lip	Asymptomatic, smooth or lobulated sub-mucosal masses	Microscopically similar to basal cell adenocarcinomas of the major gland
	Cystadenocarcinoma	32% developed in the minor glands	Palate Lips Buccal mucosa Tongue and retromolar regions	Slow growing and painless but some palatal tumors may erode the underlying bone causing sinonasal complex	---
	Salivary duct carcinoma	Rare in minor salivary glands Age range was 23-80 years (mean 56 years)	Palate (65%) Buccal mucosa and vestibule (19%) Tongue (8%) Retromolar pad (4%) and upper lip (4%)	Tumors formed painless swellings but many in the palate can be painful and ulcerated or fungated with metastases to regional lymph nodes	The range of microscopical appearances is similar to that seen in the major glands
Salivary gland adenomas	Pleomorphic adenoma	40-70% of minor gland tumors	Palate Lips and Buccal mucosa	Painless, slow growing, submucosal masses, but when traumatized may bleed or ulcerate	Biopsy shows cellular, and hyaline or plasmacytoid cell
	Myoepithelioma	42% of minor gland tumors	Palate of younger individuals	---	---
	Basal cell adenoma	20% of minor gland tumors	Upper lip Buccal mucosa	---	They are histologically similar to those in major glands.
	Cystadenoma	7% of benign minor gland tumors	Lips Cheek Palate	---	---
Kaposi sarcoma	---	Classic (elderly men of Mediterranean/EastEuropean descent) Endemic ( middle-aged adults and children in Equatorial Africa who are not HIV infected) Iatrogenic (Immunosuppressed, post-transplant) AIDS associated (HIV-1 infected individuals)	Skin ( most common) Mucosal membranes such as oral mucosa, lymph nodes and visceral organs	Purplish, reddish blue or dark brown macules Plaques and nodules that may ulcerate	Biopsy of all 4 types show: Vascular slits and sparsely distributed lymphocytes
Lymphangioma	---	Pediatric lesions Present at birth or during the first years of life Appear mostly in the head and neck area but may be found in any other part of the body	Tongue	Circumscribed painless swelling Soft and fluctuant on palpation Irregular nodularity of the dorsum of the tongue	Biopsy shows: Thin-walled, dilated lymphatic vessels of different size, which are lined by a flattened endothelium
Ectomesenchymal chondromyxoid tumour of the anterior tongue	---	Age range varies from 9-78 years No distinct sex predilection.	---	Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue	Biopsy shows: Round, cup-shaped, fusiform, or polygonal cells with uniform small nuclei and moderate amounts of faintly basophilic cytoplasm Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation
Focal oral mucinosis (FOM)	---	The lesion affects all ages Rare in children There is no distinct sex predilection.	Gingiva( most common site) Palate Cheek mucosa and Tongue	Asymptomatic fibrous or cystic-like lesion	Histopathology is characterized by: Well-circumscribed area of myxomatous tissue Fusiform or stellate fibroblasts Absent or sparse reticular fibers Mucinous material shows alcianophilia at pH 2.5
Congenital granular cell epuli	---	Affects newborns Females are affected ten times more often than males	Maxilla Mandible	Solitary, somewhat pedunculated fibroma-like lesion attached to the alveolar ridge near the midline	Ultrasound for prenatal diagnosis Immuno histochemically, the tumor cells are positive for vimentin and neuron specific enolase No reactivity with cytokeratin, CEA, desmin, hormone receptors or S-100
Hematolymphoid tumors	Non-Hodgkin lymphoma	Second most common cancer of the oral cavity	Palate Tongue Floor of mouth Gingiva Buccal mucosa Lips Palatine tonsils Lingual tonsils or Oropharynx	NHL of the lip presents with: Ulcer Swelling Discoloration Pain Paraesthesia Anaesthesia, or Loose teeth	Biopsy shows: Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology. Predominantly medium-sized cells with abundant pale cytoplasm. Large cells with round or multilobated nuclei
	Langerhans cell histiocytosis	---	Jaw bone Intraoral soft tissues Gingiva Palate Floor of mouth Buccal mucosa and Tonsil	Common oral symptoms include: Swelling Pain Gingivitis Loose teeth and Ulceration	Biopsy shows ovoid Langerhans cells with deeply grooved nuclei, thin nuclear membranes and abundant eosinophilic cytoplasm
	Hodgkin lymphoma	---	Waldeyer ring, particularly the palatine tonsil Oropharynx Alveolar crest of mandible Maxillary gingiva	Most patients present with localized disease (stage I/II), with Chronic tonsillitis or tonsillar enlargement with or without enlarged cervical lymph nodes	---
	Extramedullary myeloid sarcoma	---	Palate Gingiva	Isolated tumor-forming intraoral mass	Biopsy shows an Indian-file pattern of infiltration
	Follicular dendritic cell sarcoma / tumour	Tumor of adulthood Affects wide age range	Tonsil Palate or Oropharynx.	The patients usually present with a painless mass	Biopsy usually exhibits borders and comprises: Fascicles Whorls Nodules Storiform arrays or Diffuse sheets of spindly to ovoid tumor cells sprinkled with small lymphocytes
Mucosal malignant melanoma	---	0.5% of oral malignancies Incidence 0.02 per 100,000	80% arise: Palate Maxillary alveolus or gingivae Mandibular gingiva Others: Buccal mucosa Floor of mouth Tongue	Asymmetric with irregular outlines Macular pigmentation Nodular growth Ulceration Melanosis	Biopsy: S100 positive Negative for cytokeratins More specific markers include: HMB45, Melan-A or anti-tyrosinase