By Sergio Gandolfo; Crispian Scully; Marco Carrozzo
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24 Not all medium-large verrucous lesions are sessile. The picture shows a small base in a medium-sized lesion. Papillary-verrucous lesions PAPILLARY-VERRUCOUS LESIONS Are they small? (a few millimetres) Yes No Single? No Multiple Yes Condyloma acuminata Papilloma/verruca Is it a red lesion in the centre of the hard palate? Proliferative verrucous leukoplakia (biopsy of suspicious areas is necessary and close follow-up) They are multiple white lesions, not just verrucous and have the following clinical features: • female • no cancer risk factors • recurrent after surgery No No Yes Yes Foliate papilla hyperplasia Yes Is it on the posterior border of the tongue?
References Langtry JA, Carr MM, Steele MC, Ive FA Topical tretinoin: a new treatment for black hairy tongue (lingua villosa nigra). Clin Exp Dermatol 1992 May; 17(3):163-164 Manabe M, Lim HW, Winzer M, Loomis CA Architectural organization of filiform papillae in normal and black hairy tongue epithelium: dissection of differentiation pathways in a complex human epithelium according to their patterns of keratin expression. Arch Dermatol 1999 Feb; 135(2):177-181 Sarti GM, Haddy RI, Schaffer D, Kihm J Black hairy tongue.
References Kotlow LA Ankyloglossia (tongue-tie): a diagnostic and treatment quandary. Quintessence Int 1999 Apr; 30(4):259-262 Minor: small ulcers (<4 mm) on mobile mucosae (mostly labial and buccal mucosae), less than five ulcers at one time, healing within 14 days, erythematous borders, no vesicle formation, no scarring. Major: large ulcers (may be >1 cm), any site including dorsum of tongue and hard palate, healing within 1-3 months, with scarring. Extreme pain and lymph node enlargement are common.