Pathology · patient case question
The migratory erythematous patches with serpiginous white borders on the dorsal tongue represent:
Patient case: White and Pigmented Oral Lesions
demo: 58-year-old male
chief: Routine examination; several mucosal findings noted.
history: Smokes one pack per day for 30 years. Occasional alcohol.
meds: None
findings: Finding 1: a small white plaque on the soft palate that does not wipe off. Finding 2: a white plaque on the lateral tongue border, 3 mm, non-wiping. Finding 3: a flat blue-grey macule in the buccal mucosa adjacent to a large amalgam restoration. Finding 4: irregular erythematous patches with white serpiginous borders on the dorsal tongue that shift location between visits. Finding 5: a bony hard midline swelling of the hard palate.
Show answer and explanation
Correct answer: D. Geographic tongue (benign migratory glossitis)
- A. Hairy leukoplakia is a corrugated white lesion of the lateral tongue in immunosuppressed patients, EBV-driven and non-migratory.
- B. Median rhomboid glossitis is a fixed, well-demarcated depapillated rhomboid area anterior to the circumvallate papillae, associated with Candida.
- C. Erythroplakia is a fixed velvety red patch with high malignant potential — it does not migrate.
- D. Correct. Loss of filiform papillae in irregular zones with raised white serpiginous margins that change location over days to weeks is diagnostic of geographic tongue. It is benign; reassurance suffices.