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28 YEAR OLD MALE WITH A "FUZZY LUMP"

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CASE PRESENTED BY DR SUPEETHA SUNTHARAMOORTHY

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PRESENTATION

AGE:

28 Years

CHIEF COMPLAINT:

“Fuzzy lump” on inner aspect of lower lip

DURATION:

2-3 weeks

Figure 1: Lower Labial Mucosa

HISTORY

  • Significant stress and sleep deprivation before onset

  • Intermittent erythema and burning sensation

  • Lesions fluctuate in intensity

  • Similar smaller lesions adjacent to original site and near upper labial commissures

  • Mild intermittent tonsillar discomfort and recent self-limiting sore throat

CLINICAL FINDINGS

  • Corrugated mildly erythematous patch, faint yellow background, raised red border

  • Rough texture on palpation

  • Burning sensation

 

ADDITIONAL FINDINGS

  • Asymmetrical tonsillar enlargement with focal calcification

  • Multiple oral exostoses and tori

  • No cervical lymphadenopathy

 

WHAT IS THE
MOST LIKELY DIAGNOSIS?

A:   Oral candidosis

B:   Oral lichen planus

C:  Erythroplakia​

D:  Erythema migrans

E:   Contact mucositis

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Figure 2: Incisional biopsy

  • Non-specific inflammatory mucositis

  • No dysplasia or malignancy

KEY LEARNING POINTS

  • Erythema migrans can affect extra-lingual sites including the labial and buccal mucosa

  • Lesions may fluctuate in appearance and symptoms, mimicking more concerning inflammatory or dysplastic conditions

  • Stress, sleep deprivation, spicy foods, and local irritants may exacerbate symptoms

  • Histopathology is often non-specific and primarily useful for excluding dysplasia or other pathology

 

MANAGEMENT

  • Comprehensive intra-oral and head and neck examination including lymph node assessment

  • Clinical photography and review of lesion fluctuation over time

  • Incisional biopsy to exclude dysplasia or malignancy

  • Consider investigation for nutritional deficiencies or associated systemic factors if persistent or recurrent

  • Explanation regarding benign immune-mediated and migratory nature of condition

  • Avoidance of triggering foods and irritating oral hygiene products

  • Consider transition to non-irritating toothpaste formulations for symptomatic patients

  • Mild topical corticosteroid such as triamcinolone in orabase for symptomatic flares

 

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