White Oral Lesions: How to Distinguish the Benign From the Deadly

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 V arious mucosal abnormalities as well as proliferative and destructive lesions can occur in the oral cavity. Their causes include infectious agents, metabolic disorders, endocrinopathies, injuries, neoplasms, developmental abnormalities, genetic syndromes, and immunologic disturbances. Authors of textbooks and atlases on oral medicine classify these lesions according to their appearance1-3 or to the responsible agent.4,5 I find that classification based on a lesion’s appearance facilitates diagnosis, since the list of possibilities to consider is more finite. In a series of articles, I will offer practical advice on how to differentiate between oral lesions that require treatment—and those that may be safely left alone. Here I focus on white lesions (Table 1). In future articles, I will address erythematous, pigmented, and erosive (punctate and bullous) oral lesions.