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PART II
Soft Tissue Lesions
A
B
c
D
Fig. 5-10. Homogeneous erythroplakia. A, Very small red lesion on ventral surface of tongue, which showed invasion microscopically. B, Small red lesion on the soft palate at upper extent of pterygomandibular raphe. Lesion was barely discernible until the tissue was dried with a gauze. C, Red macule involving the sublingual papilla on the right side. D, small red lesion at posterolateral border of tongue. Excisional biopsy revealed early invasion in some sections and carcinoma in situ in others. (B courtesy R. Lee, Findlay, Ohio; D courtesy P. 0' Flaherty, Chicago, Ill.)
A
B
Fig. 5-11. Erythroplakic patches and leukoplakic patches in the same lesion. A, Lateral border of the tongue in a 64-year-old man. The red patch showed carcinoma in situ. B, Facial gingiva in a 57-year-old man. Some of the red areas showed invasive squamous cell carcinoma. (A courtesy R. Crum, Hines, Ill; B courtesy E. Seklecki. Tucson. Ariz.)
Three different clinical appearances were described by Shear J2 : (I) the homogeneous form, which is completely red in appearance (Fig. 5-10 and Plate G, I); (2) patches of EP and leukoplakia occurring together (Fig. 5-1 I and Plate G, 12); and (3) speckled EP, in which small leukoplakic specks are scattered over an area of EP (Fig. 5-12 and Plate G, 7 to G, 9). The term speckled leukoplakia used in Chapter 8 is synonymous with the term speckled EP used here. Homogeneolls EP is generally much more aggressive than leukoplakia or speckled EE I3 There is no
gender predilection and the peak age of occulTence falls between 50 and 70 years. I J The floor of the mouth is the most common site in men, whereas the mandibular gingival-alveolar mucosa-mandibular sulcus is the most common site in women. The retromolar region is the second most common site in both genders. J J
Differential Diagnosis The lesions to be considered in the differential diagnosis of erythroplakia are listed in the box on the next page.