Diagnostic algorithm for white lesions in the oral mucosa

Abstract

White lesions of the oral mucosa pose a frequent diagnostic challenge for dermatologists due to their clinical and etiopathogenic heterogeneity and variable malignant potential. This narrative review proposes a clinical diagnostic algorithm based on features such as scrapability, morphology, and location, to distinguish between benign, infectious, traumatic, reactive, inflammatory, congenital, and potentially malignant disorders. Key entities such as oral leukoplakia, oral lichen planus, pseudomembranous candidiasis, and oral hairy leukoplakia are discussed, highlighting their clinical and histopathological features and associated risk factors. The review also addresses the role of the oral microbiome, immunosuppression, and drug exposure in the development of white lesions. This work aims to improve clinical decision-making and promote early detection of lesions at risk of progressing to oral squamous cell carcinoma.