Case Number : Case 2749 - 19 January 2021 Posted By: Uma Sundram

I was wondering about oral hairy leucoplakia, because there is a hint of pallor in the upper levels of the malpighian layer.  However, this pallor is nowhere near as obvious as that shown in two previous examples of that entity (Case 622 26th October 2012; Case 2438 6th November 2019), but that may just be a staining variation.

Failing that there is psoriasiform epidermal hyperplasia with loss of filiform papillae and fusion of adjacent rete ridges suggesting geographic tongue.

Clinical details vitally important here.

Oral lesions are difficult for me.

My interpretation: Leukoplakia whit mild dysplasia.

I think we need dpas to look for fungi!

Oral lesions are challenging!

Would agree with observations of psoriasiform epidermal hyperplasia with loss of filiform papillae. I am not sure about dysplasia. The epidermis just looks strange and a bit thickened. No spongiosis/spongiotic vesicles. I agree we need fungal stains too.

Geographic tongue seems possible. Looking forward to a clinical photo...

So sorry, no clinical photo. Pt with white lesion on lateral tongue. Pas negative. Recent development after patient started chewing anti nicotine gum. This caused local irritant contact which became a white patch. 

Dx, possible irritant contact Derm from chwing/holding nicotine gum in lateral tongue. Will update w follow up if I get it.

Interesting clinicopathological correlation! Thanks for sharing this case.