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This case presentation examines the etiology, evaluation and treatment of a 57 year-old-female presenting with an area of irritation/chronic lesion on the anterior lingual surface. Orthodontic history and lingual and labial postures are discussed.
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In the course of the examination of a patient their tongue is easily visualized and with the use of gauze can be gently dried, held with gauze and stretched for inspection of all aspects. This can be followed by palpation of both the tongue and the floor of mouth. In this manner, any altered tissue is likely to be detected and, with or without further investigations, a diagnosis established. Appropriate management can then be undertaken. A wide range of conditions may involve the tongue and this article outlines some of these using a classification based on aetiology.
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BACKGROUND: Verrucous carcinoma of the oral cavity is a rare entity that was formerly controversial. Etiopathogenesis remains unclear, notably as for its possible association with lichen planus. We report a case of verrucous carcinoma occurring in lesions of lichen planus of the tongue. CASE REPORT: A 78-year old, non smoking patient, with past history of cutaneous lichen planus presented for lesions of oral lichen planus affecting both the tongue and the palate. A treatment by topical tretinoin improved him in a spectacular way and brought about a remission which lasted 5 years. A recurrence occurred when the treatment was stopped; new whitish, warty cauliflower-like lesions appeared on the tongue. A biopsy confirmed the clinical suspicion of verrucous carcinoma. A laser resection was performed. Three months later, another recurrence was observed. A chemotherapy associating isotretinoin and methotrexate eliminated all lesions. The patient's condition is considered stable, under treatment, one year later. DISCUSSION: Verrucous carcinoma is a rare slow-growing oral tumor that is chiefly exophytic and does not metastasize, but it can invade and destroy oral tissues. Its clinical presentation contrasts with benign histologic features: papillomatosis, acanthosis, dysplasia in variable degrees. The occurrence on lesions of lichen planus, although "classic", is very rarely found in the literature. The treatment is not well codified. An additional chemotherapy seems necessary to prevent recurrences.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.