Help with dx and diff dx

[easyas123]

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This 40 year old African American female presents for routine dental care. There are no oral

complaints . She has no medical issues, and no tobacco/alcohol history. Her oral examination

reveals abnormal findings involving the lower labial mucosae and anterior buccal mucosae . She

is aware of these findings and says they have been present for a couple of years .

I have attached an image.

Would you do a biopsy? If so, velscope? What kind.

This is for educational purposes, not a real patient of mine.

 

[deleted314957]

Of course he needs a biopsy. Why use an expensive “adjunct” like fluorescence?
This patient has patently visible lesions that require an incisional biopsy.I don’t think you need to go on a sophisticated “hunt” for suspicious looking mucosa with multi thousand dollar machines.
And what would you do if the scope gave negative or equivocal results?

 

[easyas123]

What would be your differential diagnoses?

 

[Path or bust]

This 40 year old African American female presents for routine dental care. There are no oral

complaints . She has no medical issues, and no tobacco/alcohol history. Her oral examination

reveals abnormal findings involving the lower labial mucosae and anterior buccal mucosae . She

is aware of these findings and says they have been present for a couple of years .

I have attached an image.

Would you do a biopsy? If so, velscope? What kind.

This is for educational purposes, not a real patient of mine.

Aphthous Stomatitis probably
Behcet Disease (not common in US and much more common in Males, usally multi system and see genital ulcers),
Reiter Disease
Traumatic ulcerative granuloma (unlikely due to more than one).
Crohns (unlikely if there are no GI complaints of diarrhea or bloody stools)
HSV 1 (usually presents on keratinized mucosa and on lip vermilion)