Gary Goldenberg, MD


December 29, 2011

History and Clinical Presentation

A 53-year-old woman presented for evaluation with a chief complaint of a persistent, painless "spot" in her left buccal cheek (Figure 1).

Figure 1. Patient's initial symptom.


Previous treatments included topical corticosteroids and emollients. A review of systems was negative. She had a biopsy that showed epithelial hyperplasia without atypical cells. She reported no family history of skin or mucosal disease and denied a history of smoking.

Physical Examination

Examination revealed a white plaque on the left midbuccal mucosa without evidence of bleeding. The lesion was nontender to palpation.

Diagnostic Evaluation: Biopsy

A biopsy was performed and showed crusting and epithelial hyperplasia with crowding on cells along the basal layer. Pushing borders were noted in several areas. Areas suggestive of viropathic change were noted in the upper layers of the epithelium (Figure 2).

Figure 2a. Low-power view shows epithelial hyperplasia with crusting. Crowding is noted along the basal layer. 2b. High-power view shows areas suggestive of viropathic changes with hypergranulosis and crusting. 2c. High-power view shows crowding of the basal layer with hyperchromasia and pushing borders.


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