Table 1 Differential diagnoses of long-lasting oral erosive lesions based on existing literatures
Diagnosis | Manifestation | Potential adjuvant examinations |
|---|---|---|
Bullous lesions, irregular erosion, hyperemic lesion, Nikolsky’ sign of oral mucosa and/or skin No systemic involvement of other organs | HE: subepithelial or intraepithelial bulla DIF: linear or reticular deposition of C3, IgG, IgA and IgM in the basement membrane or in the intraepithelial area | |
Erosions or bulla of the skin and mucous membrane accompanied by occult tumors | HE: loosening of spinous layer, keratinocyte necrosis, interface dermatitis DIF: deposition of C3, IgG and/or IgA and IgM in the intraepithelial area and basement membrane | |
Infectious diseases | ||
Secondary syphilis: round gray-white plaques, congested, diffusely flushed mucosa with erosions or ulcers | Blood test: non-syphilis spirochete antigen serologic test and specific syphilis spirochete antigen serologic test HE: endovasculitis | |
AIDS [21] | Oral candidiasis; Deep or recurrent oral ulcers; Other non-specific oral lesions | Blood test: HIV antibody |
Hard nodules, long-lasting erosions or deep ulcers or with irregular margins in the oral mucosa | HE: typical Langerhans giant cells Positive result of acid-fast staining and PCR for TB DNA | |
OPMD | ||
Erosions, typical symmetrical white striae | HE: hyperkeratosis, liquefied degeneration, and infiltration of band-like lymphocytes | |
OLK [25] | White plaques with erosive and/or ulcerative lesions | HE: epithelial hyperplasia with hyper parakeratosis or hyper(ortho)keratosis, various degree of epithelial dysplasia |
OE [25] | Demarcated and flat scarlet patches accompanied with erosions or ulcerations | HE: Epithelial atrophy and lack of stratum corneum with diverse degree of epithelial dysplasia |
DLE [26] | Reddish area with central atrophy and depression with concomitant erosions | HE: Liquefaction of basal cells and perivascular lymphocytic infiltration, epithelial atrophy and lack of stratum corneum |
OSCC [14] | Localized ulcer and erosions with firm texture | HE: presence of typical squamous cell carcinoma |
Proliferative pustular lesions and subsequent erosions in the oral mucosa | HE: acanthosis, intraepithelial and subepithelial micro abscesses, accompanied by infiltration of neutrophils and eosinophils Colonoscopy: inflammatory bowel disease | |
Ulcers or erosions with inflammatory reddened margins and tenderness | HE: eosinophilic granuloma and LCH cells IHC: CD1a or S100 or Langerin positive CT: cranial or maxillofacial bone abnormalities | |
Dyskeratosis congenita [8] | Mucosal leukoplakia, persistent oral mucosal erosions | Whole exome sequencing HE: non-specific inflammation Bone marrow aspiration: aplastic anemia |