Differential diagnosis and management of oral ulcers

hile many oral ulcers are the result of chronic trauma, some may indicate an underlying systemic condition such as a gastrointestinal dysfunction, malignancy, immunologic abnormality, or cutaneous disease. 1 Herein, we will discuss how to differentiate and diagnose varying types of oral ulcers and provide treatment strategies. Neoplasm Oral squamous cell carcinomaOral squamous cell carcinoma (SCC) presents in several clinical forms: either as a white lesion (leukoplakia), a red lesion (erythroplakia), a red and white lesion (erythroleukoplakia), an indurated mass, or as a mucosal ulcer.The floor of the mouth (Figure 1A) and lateral tongue (Figure 1B) are the most common intraoral sites for this malignancy.The major risk factors for oral cancer include tobacco use and alcohol consumption.SCC of the lip, associated with ultraviolet (UV) light and pipe smoking, often presents as a chronic, nonhealing ulcer (Figure 1C) at the vermillion border.This form of cancer can be similar in appearance to several other ulcerative conditions, including recurrent herpes simplex virus 1(HSV-1). 2Cancer of the lower lip has a 5-year survival rate of 90%, which is higher than the generally quoted 5-year survival rate for intraoral cancer of 40% to 50%. 2 Approximately 80% of tongue n