Erythematous Oral Lesions: When to Treat, When to Leave Alone

Dr Lawson is professor of otolaryngology at the Mount Sinai School of Medicine in New York City. WILLIAM LAWSON, MD, DDS Mount Sinai School of Medicine I f you know what to look for, the appearance of a puzzling oral lesion can help you narrow the possible causes. In previous issues of CONSULTANT (April 2012, page 301, and May 2012, page 347), I provided tips for identifying and managing white and pigmented oral lesions, respectively. In this article, I consider erythematous oral lesions, the appearance of which reflects the increased vascularity of the local tissues. In some cases, the increased vascularity results from denudation or inflammation of mucosal or gingival areas by such diverse causes as allergy; fungal infection; dermatologic, hematologic, metabolic, and immunologic disorders; and neoplasia. The lesions associated with these erythematous mucosal alterations are generally flat or atrophic; however, epithelial hyperplasia is seen with erythroplakia and psoriasis. In other erythematous oral lesions, vascular hyperplasia occurs, such as in Sturge-Weber syndrome. This may also take the form of neoplastic proliferations (hemangioma and Kaposi’s sarcoma), vascular malformations, or ectatic vessels (hereditary hemorrhagic telangiectasia). Finally, hyper vascularized masses may appear on the gingiva in response to local trauma or irritaABSTRACT: Erythroplakia requires biopsy followed by wide local excision, since about 50% of these lesions represent invasive carcinomas. Geographic tongue and erythema migrans are largely benign; treatment is symptomatic if patients complain of pain. Red lesions caused by hyper­ sensitivity to drugs, foods or, most commonly, dental materials (eg, denture adhesives, toothpastes, and mouth rinses) can arise anywhere in the oral cavity. Treatment consists of discontinuing the offending substance; up to 40 mg/d of prednisone can promote healing. Biopsy is not necessary for most vascular erythematous oral lesions, except Kaposi’s sarcoma. If vascular lesions are traumatized, surgery or embolization may be needed to control bleeding. Because pyogenic granuloma and peripheral giant cell granuloma can resemble amelanotic melanoma, they require biopsy. Treatment is excision.