Review Article

Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree

Table 2

Clinical characteristics of chronic oral ulceration [14, 11, 2028].

LesionGender predominanceAge predilectionLocationShape of ulcerNumber of ulcersDistinguishing features

Sustained traumatic ulcerNANATongue, lips, buccal mucosaSymmetrical/asymmetricalSolitaryCentral removable, yellow fibrinopurulent membrane; a raised, rolled border of hyperkeratosis immediately adjacent to the area of ulceration

Necrotizing sialometaplasiaMenAverage age: 46 yearsPalate, retromolar pad, lipsCraterlikeSolitaryDeep ulcer with a yellowish base, self-limiting, healing time between 2 and 12 weeks

Eosinophilic ulcerWomen40–60 years Tongue, buccal mucosaPunched outSolitarySlow-healing ulcer with a rolled border, surrounding erythema or keratosis, mostly asymptomatic, healing time between 1 week and 1 year

Ulcerative squamous cell carcinomaMen>40 yearsLower lip, floor of the mouth, tongueCraterlikeSolitaryRolled, indurated borders and a velvety base

Cytomegalovirus-associated ulcerationNANAKeratinized and nonkeratinized mucosaLarge ulcerSolitary, rarely multiplePainful, necrotic, with minimally rolled border, mostly in immunocompromised patients

Tuberculous ulcerMenNATongue, gingivae, floor of the mouthUndermined bordersSolitaryMay be ragged and indurated, often painful

Syphilitic ulceration (chancre)NANALips, tongue, palateClean-based ulcerationSolitaryRed purple or brown base, ragged rolled border, cervical lymphadenopathy

Oral blastomycosisMenNAAny oral mucosal surfaceNonspecific ulcerSolitaryPainless, irregular rolled borders and verrucous mucosal hyperplasia, painful, concomitant pulmonary lesions on chest radiographs

Oral mucormycosisNANAPalateVerrucous ulcerSolitaryLarge deep necrotic ulcer, associated with concomitant pulmonary disease and an underlying debilitating disease

Pemphigus vulgarisNANABuccal mucosa, palate, gingivaeMap-likeMultipleShallow irregular ulcers with peripheral extension, positive Nikolsky sign, desquamative gingivitis

Mucous membrane pemphigoidWomen>50 yearsGingivae, buccal mucosa, palateNonspecific-appearing erythema and erosionsMultipleDesquamative gingivitis as the most common oral presentation, blood blisters, skin lesions in 30–40% of cases

Bullous pemphigoidNA>60 years of ageGingivaeDiscrete vesicle formationMultipleDesquamative gingivitis as the most frequent oral manifestation, self-limiting, early remission

Lichen planusWomenMiddle ageBuccal mucosa, tongue, gingivaeMultipleAccompanying reticular or papular lesions, desquamative gingivitis, painful

Linear IgA diseaseWomen6th and 7th decades of lifeHard and soft palate, tonsillar pillars, buccal mucosaClinically indistinguishable from the oral lesions of MMPMultipleVesicles, painful ulcerations or erosions, desquamative gingivitis/cheilitis

NA: not assigned.