Have you noticed a wound in your mouth that is not healing? Maybe you also noticed it has a bump or area that seems unnaturally firm to the touch? If these symptoms sound familiar to you, you may have an oral lesion.
Mohemmed Nazir Khan, MD
In this Q&A, Mohemmed Nazir Khan, MD, an Assistant Professor at the Department of Otolaryngology at Mount Sinai-Union Square and a surgeon at Mount Sinai’s Head and Neck Institute—Center of Excellence for Head and Neck Cancer, explains the importance of detecting oral lesions early. While regular dental appointments are important, anything that looks or feels suspicious should be checked out immediately.
“Even if it turns out to be nothing, it is better to be safe than sorry,” he says. “I know the thought of a consultation can be scary, but the earlier we intervene, the better your outcomes will be.”
What is an oral lesion?
An oral lesion is an abnormal cell growth in your mouth, which has the potential to become cancerous. There are several telltale signs that you should look for, including:
- A cut or sore in the mouth that becomes painful and has an underlying bump. This may be accompanied by bumps on the neck, but they are rare.
- Unusual white or angry-looking red patches; an ulcerated, or cratered, lesion that is painful.
- An unusually firm area of your mouth.
- Numbness or loss of function, such as your tongue deviating to one side when you stick it out.
What is the difference between an oral lesion and a canker sore?
You may mistake some signs of oral lesions for a canker sore, formally known as an ‘aphthous ulcer.’ However, there are several key differences. For one, an oral lesion is not usually painful when it first appears, unlike a canker sore. Also, canker sores tend to be flat, with edges that appear angry and red. Most important of all, a canker sore will usually heal in two to three weeks. An oral lesion will not.
Usually, an oral lesion is easy to spot because it is front and center, such as on the tongue. If you have a wound or area of firmness in your oral cavity that does not get better over the course of a month, you need to have it examined because that is an indicator of an oral lesion.
Oral lesions are not commonly associated with the human papillomavirus (HPV). Furthermore, the signs are similar for both adults and children. However, the lack of risk factors among young people suggests that there is a genetic predisposition at play. This does not rule out environmental triggers, such as scratching from a misaligned incisor. But the hypothesis is that the irritation is the spark that lights the match for the genetic predisposition.
What are the most common types of oral lesions?
There are six different kinds of oral lesions:
- Oral lichen planus, a chronic inflammation that often appears as white patches on your inner cheek or other parts of your mouth, which has no known cause.
- Candidiasis, a fungal infection caused by candida, a type of yeast, which often appears as white patches in your mouth with some degree of redness or soreness.
- Leukoplakia, white patches typically caused by constant injury or irritation.
- Erythroplakia, which appears as red lesions in the mouth, bleeds when irritated, and is linked to alcohol and tobacco use.
- Oral cavity cancer, which often appears as a sore or lump on the lips or in the mouth, and is also linked to alcohol and tobacco use.
- The herpes simplex virus, which often appears as a cluster or a single small painful blister in the mouth, but may also look like a sore.
What should I do if I think I have an oral lesion?
You should make an appointment with a dental professional for a physical examination. In cases where your doctor has a high clinical suspicion of oral lesions, such as angry red patches, a biopsy may be performed, which will be done in the office. This involves numbing the area before removing a small sample for analysis. For patients who present with enlarged lymph nodes, a doctor normally collects a sample using a needle biopsy. The biopsy is invaluable because it establishes the diagnosis so the doctor can proceed with treatment. It also gives us the ability to reassure patients who have a premalignant lesion that just requires monitoring.
In cases involving cancerous or moderate-to-high risk precancerous lesions, doctors may recommend surgical removal. This is typically done using open surgery as most patients present with oral lesions on the tongue. However, at Mount Sinai’s Head and Neck Institute—Center of Excellence for Head and Neck Cancer, we are typically able to remove most oral lesions with few incisions. But we will remove the lymph nodes from the neck on the ipsilateral—or the same side—as the lesion if the tumor has a thickness of four millimeters or more. In cases involving bone structure, such as the jaw or midface, we will remove the lesion in collaboration with oral and maxillofacial surgeons. This allows us to better reconstruct boney structures and also achieve the best outcomes for your dental rehabilitation.
If the diagnosis reveals that the lesion is a stage two or higher cancer, we will recommend radiation therapy post-surgery. We will also recommend chemotherapy if there are positive margins following surgery—meaning that not all of the cancer could be removed—or if there is extranodal extension of the tumor, which means that the cells have spread beyond the lymph nodes.
For tumors that are located low on the tongue, or close to the floor of the mouth, we recommend microvascular reconstruction using skin and fat from other parts of the body. This allows us to preserve essential functions, such as your ability to eat and talk.
What should I expect following treatment?
Recovery differs based upon the extent of the surgery. For example, patients who undergo primary tumor removal without reconstruction are often discharged the same day and are started on a soft diet to promote healing. Patients who undergo lymph node removal are normally discharged the next day with a drain. Patients who undergo bone reconstruction are fitted with a nasogastric tube for a week to promote healing. In all cases, the goal at Mount Sinai is to get you back to eating and drinking as quickly as possible.
After surgery, we consult with patients every two months for the first year and conduct a surveillance scan at three months to ensure that all looks well. If subsequent scans show no signs of lesions, we gradually reduce the number of consultations to once a year after year five.
How can I prevent oral lesions?
You can take several steps to reduce your risk of developing an oral lesion:
- Maintain a healthy diet
- Practice proper oral hygiene by brushing and flossing daily
- Avoid betel nut chewing, which can lead to significant scaring and increased risk for oral cancer
- See a dental professional twice a year