Solitary Oral Ulcers and Fissures
CHAPTER II
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c c Fig. 11-18. Rare oral ulcers. A, Metastatic carcinoma from squamous cell carcinoma of the esophagus in a 46-year-old man. B, Palatine lesion of psoriasis. C, Benign mucous membrane pemphigoid. (A courtesy E. Robinson. Toledo, Ohio; B, courtesy P.D. Toto, Waukegan, III; C courtesy D. Bonomo, Flossmoor. ilL)
Fig.B-17. A and B, Two cases of necrotizing sialometaplasia on the palate. C, Midline nonhealing granuloma. (A courtesy A. Abrams, Los Angeles; B courtesy C. Dunlap, and B. Barker. Kansas City, Mo: C courtesy S. Goldman, Hinsdale, III.)
I, The complaint of pain in an oral ulcer does not permit a definite identification of the ulcer, since the majority of oral ulcers, regardless of their cause, may soon become painful from contamination by the oral liquids and tlora, 2. Because of contamination by oral fluids, a painful regional lymphadenitis almost always accompanies oral ulcers, Consequently the presence or absence of pain in the ulcer or the associated enlarged nodes is not a conclusive diagnostic feature, Exceptions to this rule are squamous cell carcinoma and other peripheral malignancies, which are characteristically painless early in their course because
most of the peripheral sensory nerve endings are destroyed or their surfaces are covered by tumor epithelium. These malignant lesions often do not become painful until they have attained a large size. When metastatic spread to regional lymph nodes has occulTed, the enlarged nodes are likewise characteristically painless, as well as quite firm. Again, it should be emphasized that these characteristics are not diagnostic because entities such as benign lymph node hyperplasias and enlarged fibrosed nodes are usually firm and painless. Short-term ulcers are shallow lesions: they are not raised above the mucosal surface. In contrast. persistent ulcers frequently are associated with extensive borders and bases (see Fig. I 1-1 I, B).