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Clinical descriptive terminologies

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CLINICAL DESCRIPTIVE TERMS

Author: Sanketh DS, MDS

All clinicians should be familiar with the descriptive terms used to describe any lesion. The clinician, by doing so can efficiently and uniformly describe a lesion, which could also help in listing them with respect to differential diagnosis.

MACULE

Focal/circumscribed area of the mucosa, that can be distinguished from its surroundings by its colour. It is neither elevated nor depressed and can be blue,brown or black in colour. This term is reserved for lesions that are 1 cm or smaller in size.
Eg – Oral melanotic macule

PATCH

Focal/circumscribed area of the mucosa, that can be distinguished from its surroundings by its colour. A patch is neither elevated nor depressed and is greater than 1cm in size(larger than macule).
Eg – Mucous patches in syphilis, melanoacanthoma

PLAQUE

Is a solid, slightly elevated lesion that is flat on its surface and is greater than 1cm in diameter.
Eg – leukoplakia, lichen planus

PAPULE

Is a solid raised, superficial lesion lesser than 1 cm in diameter.
Eg – papules may be seen in erythema multiforme, lupus erythematosus, rubella

NODULE

Is a solid raised lesion greater than 1cm in diameter and has the dimension of depth and extend deeper into the connective tissue.
Eg – Benign mesenchymal tumors like neuroma, fibroma,lipoma

VESICLE

Is a circumscribed elevated fluid filled blister that is under 1 cm in diameter. Vesicles may contain serum or lymph or may sometimes be filled with blood. Vesicles may breakdown to give rise to ulcers or erosions.
Eg – May be seen in herpes simplex, herpes zoster

BULLA

Is a circumscribed elevated fluid filled blister greater than 1 cm in diameter. Usually occurs as a result of accumulation of fluid in the epithelium-connective tissue interface or a split in the epithelium.
Eg – are seen in pemphigus, pemphigoid, erythema multiforme

PUSTULE

Is a circumscribed elevated blister that develops due to accumulation of purulent exudate (pus). Are usually less than 1 cm in diameter and appear creamy white to yellowish in colour.
Eg- May appear in herpes zoster, vesicullo-bullous lesions like pemphigus

EROSION

Are lesions that usually arise as a result of rupture of a vesicle or bulla. Erosions are moist and slightly depressed, and are superficial denudations of the epithelium (above the basal layer).
Eg- may be seen in pemphigus, pemphigoid, oral lichen planus

ULCER

Are well circumscribed, depressed lesions with a break in the continuity of the epithelium. The disruption in the epithelium extends beyond the basal layer and into the connective tissue. Ulcers are usually painful.
Eg – may be seen in vesicullo-bullous lesions, viral infections like herpes simplex,herpangina, apthous stomatitis

FISSURE

This may be a normal or abnormal linear slit in the epithelium, that usually occurs in the lips and perioral tissues. It may harbour inflammation and ulcerations if infected.
Eg- Angular cheilitis, Exfoliative cheilitis

TUMOR

Is a term usually representing a neoplasm, is used to describe any solid tissue enlargement. Tumors often appear as raised rounded lesions and have dimensions of depth. However, it is usually avoided as a clinical descriptive term and terms like “nodule”, “mass” or “swelling” are preferred.
Eg- neurofibroma, granular cell tumor, fibroma

CYST

Is defined as a pathological cavity, lined by epithelium, having fluid, semifluid or gaseous content that are not created by the accumulation of pus. Their size may range from a few millimetres to few centimetres.
Eg – radicular cyst, dermoid cyst, lymphoepithelial cyst, naso-alveolar cyst

CRUST

Is dried blood, serum and other exudates covering an ulcerated area. This area is termed as a pseudomembrane if its moist!
Eg- Erythema multiforme, other vesicullo-bullous lesions, herpes simplex

PETECHIAE

Are minute pin-point haemorrhages into the skin/oral mucous membrane that may be 1-2mm in diameter.  Usually occurs when there is increased vascular pressure or low platelet counts (thrombocytopenia).

PURPURA

These are haemorrhages that are slightly larger than petechiae (> 3mm). They are associated with the same diseases causing petechiae.

ECCHYMOSES

Are haemorrhages (bruises) larger than purpuras  (>1 to 2cm).

VERRUCOUS

The term “verrucous” refers to wart like projections on the surface of a lesion.
Eg – Verrucous carcinoma, Verrucous leukoplakia

PAPILLOMATOUS

The term “papillomatous”  refers to cauliflower like or nipple like projections on the surface of a lesion. They are often pedunculated.
Eg – squamous papilloma, verucca vulgaris, condyloma acuminatum

REFERENCES

Neville BW, Damm DD, Allen CM, Chi A. Oral and Maxillofacial Pathology. South Asian ed. Elsevier; 2016.

Langlais RP, Miller CS, Nield-Gehrig JS. Colour Atlas of Common Oral Diseases. Lippincott Williams & Wilkins; 2009.

Greenberg MS, Glick M, Ship JA. Burket’s Oral Medicine: Diagnosis & Treatment. 11 th ed. BC Decker; 2008.

Scully C, Flint S, Porter SR, Moos K, Bagan J. Oral and Maxillofacial Diseases. 4 th ed. CRC Press; 2010.

McCann AL, Wesley RK. A method for describing soft tissue lesions of the oral cavity. Dent Hyg (Chic). 1987 May;61(5):219-23.

Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran: Pathologic Basis of Disease. 8 th ed. Elsevier; 2010.

OTHER (HACKDENTISTRY) PRACTICE/STUDY RESOURCES

Oral Pathology & Medicine Question Bank 

Oral Pathology & Medicine Test Series


Oral Pathology & Medicine Illustrated Scripts


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