• Granular cell layer
• Nuclei lost in the keratin layer

• No granular cell layer
• Nuclei retained in the keratin layer

• Hard palate
• Gingiva
• Alveolar mucosa
• Dorsal tongue

• Buccal/labial mucosa and vestibule
• Floor of mouth
• Lateral tongue
• Soft palate
• Gingival sulcus

• Common
• Normal variation
• Prominent in darker skinned individuals
• Somewhat folded or wrinkled

• Bilateral buccal mucosa
• May also involve floor of mouth

• Stretch tissue for whiteness to disappear
• No malignant potential
• Not leukoplakia

• Unknown
• Decreases with smoking cessation

• Acanthosis
• Parakeratosis
• Intracellular edema

• Hyperorthokeratosis
• Intracellular edema

• Biting buccal mucosa
• Or negative pressure due to sucking cheeks

• Oral lesion
• Most common true neoplasm

• Tongue
• Lips
• Buccal mucosa
• Gingiva
• Soft palate

• At any age
• Usually adults

• Exophytic "cauliflower like" soft lesion
• Most pedunculated
• White or pink (depends on hyperkeratosis)

• Usually few millimeters in diameter (0.5 cm)
• But up to 1.5 cm

• Human papilloma virus (HPV)
• Especially subtypes 6 and 11 in half of all lesions

• Long thin finger like projection of squamous epithelium
• Thin connective tissue core

• Excisional biopsy including base of lesion
• Vaccine for HPV types 6, 11, 16 and 18

• Vermillion border
• Labial mucosa
• Anterior tongue
• Commonly hands and fingers

• Finger like projection
• Contagious
• Some may show keratin horn

• Viral inclusion may be seen in upper spinous layer
• Inflammation in connective tissue

• Most common in anogenital skin
• Tongue
• Buccal mucosa
• Palate
• Gingiva

• Up to 2 cm in diameter
• Larger than squamous papilloma

• American Indians
• Also eskimos

• Usually on lower lip
• Buccal mucosa
• Commissures
• Upper lip
• Tongue

• Acanthosis
• Mitosoid cells
• No hyperkeratosis

• Anywhere in mouth
• Also on skin or genitalia

• Unknown
• Probably not HPV
• May be unusual response to injury

• Verrucous hyperparakeratotic surface with elongated rete ridges
• Large swollen "foam" cells

• Uncommon
• Usually solitary lesion
• Sessile or pedunculated

Rough or pebbly surface

• Keratoacanthoma
• Verruciform xanthoma

• On sun exposed skin
• Rarely occurs intraorally

• Grows to full size in 4 - 8 weeks
• Static for another two months
• Then undergoes spontaneous regression

• Growth
• Stationary
• Involution

• Self limiting benign lesion
• Elevated crater with depressed central plug
• Solitary or multiple
• May be painful

• Unknown
• Possible sun damage
• May arise from hair follicles

• Excision with follow up
• May cause significant scarring if not excised

• Buccal mucosa
• Palate
• Gingiva
• Floor of mouth
• Tongue

• Childhood onset
• May be present at birth
• Or develop early in childhood or adolescence

• Rare
• Autosomal dominant
• White opalescent hue
• Usually bilateral

• Acanthosis
• Hyperparakeratosis
• Intracellular edema
• Parakeratin plugs may run deep into spinous layer

• None
• But biopsy to confirm diagnosis
• No malignant transformation

• White patch on the mucosa that will not wipe off
• Only a clinical term
• Most common premalignant lesion of the oral cavity

• Focal hyperkeratosis
• Idiopathic leukoplakia
• Frictional keratosis

• Frictional keratosis
• Smoking related leukoplakia
• Smokeless tobacco keratosis

• Leukoplakia not related to smoking or chronic irritation

• Non malignant lesions
• Similar to callous on skin

• Tobacco
• Betel quid
• Alcohol abuse
• Ultraviolet radiation
• Candida
• Vitamin deficiency (iron deficiency anemia)
• Syphilis
• Sanguinaria, etc.

• Floor of mouth
• Lateral border and ventral surface of tongue
• Soft palate

• Mild or thin
• Homogenous or thick
• Granular or nodular
• Verrucous or verruciform
• Proliferative verrucous leukoplakia (PVL)

• Small localized area to large diffuse lesion
• May be multifocal
• Non palpable to leathery areas

• Acanthosis
• Hyperkeratosis
• Hyperparakeratosis
• Possibly mild inflammation

• Eliminate causative agent
• Surgical removal
• Close follow up every 6 months if benign

• Chewing tobacco
• Moist snuff
• Dry snuff

• Crest of edentulous ridge
• Retromolar pad distal to second molar
• Tongue
• Lip
• Hard and soft palate

• Alterations of taste
• Increased periodontal disease
• Caries
• Dental abrasion
• Pumice or sandpaper like