Pathology · patient case question
What is the diagnosis for Patient C?
Patient case: Three tongues and a salivary gland
Patient: Three separate patients
Chief Complaint: A: reduced salivation on one side after surgery in the floor of the mouth. B: “My tongue has cracks in it — is something wrong?” C: “The red patches on my tongue keep moving around.”
Background: A, 55-year-old male: recent excision of a floor-of-mouth lesion. B, 46-year-old female: asymptomatic, noticed the appearance for years. C, 33-year-old male: mild sensitivity to acidic and spicy food; history of psoriasis.
Findings: B: deep grooves radiating across the dorsum of the tongue, no induration, no ulceration. C: well-demarcated red depapillated patches with raised white serpiginous borders, in different locations from those photographed at a visit three weeks ago.
Show answer and explanation
Correct answer: D. Geographic tongue (benign migratory glossitis)
- A. Lichen planus produces bilateral lacy WICKHAM STRIAE, most characteristically on the buccal mucosa, and its lesions persist in place rather than migrating.
- B. Squamous cell carcinoma is a persistent, INDURATED, progressively enlarging lesion of the lateral border. A lesion that MOVES is not a carcinoma, and that is the single most reassuring discriminator available at the chairside.
- C. Erythematous candidiasis gives a diffuse red and often painful tongue, classically following antibiotic or inhaled steroid use or beneath a denture, and it responds to antifungal therapy. It has no raised serpiginous white border and does not move.
- D. CORRECT. BENIGN MIGRATORY GLOSSITIS, also called erythema migrans or geographic tongue. The defining feature is exactly what this patient describes — MIGRATION. Lesions heal in one area and appear in another over days to weeks, which no neoplastic or infective process does. The appearance is of well-demarcated depapillated red patches with raised white serpiginous margins. Histologically it resembles psoriasis, and it is associated with PSORIASIS and with FISSURED TONGUE, both relevant here. It is entirely benign.
Note: Management is reassurance. A minority of patients report sensitivity to acidic, spicy or salty food, which is managed by avoidance and occasionally a topical corticosteroid or topical anaesthetic rinse. Documenting the lesion photographically at one visit and comparing at the next is a simple and convincing way to demonstrate migration to an anxious patient.