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This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient's complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases.

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ABSTRACT This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient's complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases.

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Objectives: There is conflicting evidence as to whether oral lichen planus (OLP) can undergo malignant transformation into oral squamous cell carcinoma (OSCC). This study aimed to address this issue by analyzing a sample of Brazilian patients with either OLP or OSCC. Patients and Methods. This study was conducted in São Paulo, the world's fourth-largest city by population. Two groups of patients were analyzed. The OLP group consisted of 370 patients, while the OSCC group consisted of 154 patients. The OLP patients were followed up for up to 21 years to monitor clinical benefits from the management or changes in the lesion morphology; conversely, patients with OSCC were examined only twice for diagnostic purposes and referred to a specialized center. Data concerning systemic diseases, use of medications, type of oral lesions, and health-risk behaviors were recorded for patients in both groups. Results: None of the patients with OLP developed OSCC at the lesion site. Only one female patient with erosive OLP developed OSCC in the normal, lesion-free oral mucosa. None of the OSCC patients had concomitant OLP lesions; however, a higher percentage of OSCC cases (17.5%) showed white plaques (most likely oral leukoplakia) as a precursor lesion. Conclusion: The findings strongly suggest that malignant transformation of OLP is virtually nonexistent in the Brazilian population.

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Oral leukoplakia (OL) has the potential for malignant transformation; unfortunately, there are no strategies to prevent this possible outcome. Surgical intervention has been reported to be effective in reducing but not eliminating the risk of malignant transformation. Meta-analyses have reported that patients who underwent excision of OL lesions had a significantly lower chance of malignant transformation than those whose lesions were not excised. The present study aimed to report a case of successful management of extensive OL using a high-power laser. The patient has been under periodic monitoring, and we aim to continue the follow-up as long as possible. Recurrence or signs of malignancy were not observed at the 2-year follow-up.

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Considering previous data from our clinic, as had consistently demonstrated a significant number of OLP patients also reporting thyroid disease (Hashimoto's thyroiditis, in particular), the present study investigated the prevalence of OLP in patients with autoimmune thyroid disease, including Hashimoto's thyroiditis and Graves' disease.

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Oral mucosal lesions presenting as erythematous patches usually pose difficulties for a clinical diagnosis. They elicit an array of differential diagnosis that mainly includes oral candidosis, contact mucosal reaction, oral lichenoid lesion, oral psoriasiform, autoimmune disease, and, not to forget, secondary syphilis. In this present case, all those above-mentioned possibilities were ruled out, while secondary syphilis stood as the main diagnosis. As this was also later excluded by a negative serological treponemal test, the final diagnosis rested on an ectopic manifestation of benign migratory glossitis (BMG), whose diagnosis was based on the clinical aspects of the lesions, along with their spontaneous disappearance in a short period of time (a hallmark of this condition) and the presence of fissured tongue, a manifestation that occurs very often in concomitance with BMG.

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Cheilitis glandularis (CG) is an inflammatory condition of unknown cause that predominantly affects the minor salivary glands of the lips. Although a diagnosis of CG is not difficult, its treatment is a challenge. This article highlights the clinical presentation of the disease together with a case of successful management of this disease using a combination of a steroid injection followed by a topical immunosuppressor.

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INTRODUCTION: To analyze factors that may affect recurrence, development of new lesions, and malignant transformation in patients with oral leukoplakia (OL) following surgical treatment with lasers. MATERIALS AND METHODS: A total of 40 patients were enrolled in this study, 17 females (mean age of 64.5 years; 33-88 years) and 23 males (mean age of 56.6 years; 28-84 years) with an overall mean age of 60.5 years. A total of 49 lesions were diagnosed and treated; 9 patients had more than one site affected. Mean time of follow-up was 22 months (6-71 months). Data were assessed by univariate Cox and multivariate Cox regression analyses. RESULTS: Recurrence (OL at the same site of the initial lesion) was observed in 11 patients (27.5%) while 4 patients (10%) developed new lesions, and 2 patients (5%) experienced malignant transformation. Only two clinical factors were statistically associated with the outcome for the development of new lesions: patients ≥ 60 years and female gender (p < 0.1). Neither of the outcomes of recurrences and malignant transformations was significantly correlated with any of the risk factors analyzed. CONCLUSION: Surgical laser is not a deterrent for the outcomes evaluated; additionally, the design of this study did not allow us to determine whether the laser treatment had provided a great benefit by significantly reducing the rate of malignant transformation among the patients. CLINICAL SIGNIFICANCE: It is highly important to inform patients with OL that their condition can be treated, when possible, by surgical laser, and that this treatment may be helpful in bringing down the odds of malignant transformation of their lesions. In addition, the patients should also be brought to the attention of the necessity of a continued clinical monitoring regardless of the outcome following a surgical intervention.

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OBJECTIVE: Extensive vascular malformations (VM) pose difficulties for an effective management. INTRODUCTION: This article describes a very satisfactory result, both functional and aesthetic, following a management by the technique of photocoagulation using diode laser in an extensive VM lesion involving the lower lip and left buccal mucosa in a 25 year old male. CASE REPORT: The patient reported that the lesion had been present since birth. The whole treatment, carried out under local anesthesia, spread over 6 months since as many as 4 sessions of laser, with a 1.5-month interval in each, were required. The resting period between sessions played an important part in treatment by allowing a time for the recovery of the patient and the shrinking of the lesion. CONCLUSION: The patient had no complications during the laser sessions, and his postoperative period was uneventful. No recurrence has been seen after a 2.5-year follow-up.

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INTRODUCTION: Predisposing factors in chronic hyperplastic candidosis (CHC) have been poorly recognized. This study aimed at assessing the prevalence of Candida spp. in areas of the oral mucosa showing greater prevalent rate of CHC, such as the retrocomissural area, the lateral borders of the tongue, and the hard-palate mucosa in four groups of individuals presenting predisposing factors as follows: Smoking habits (group I); patients with low salivary flow rate (SFR) (hyposalivation - group II); patients with loss of vertical dimension of occlusion (LVDO -group III); and control subjects (group IV). MATERIALS AND METHODS: A total of 44 individuals (age 4090 years, mean: 55.8 years) were divided into four groups: Group I (11 smokers); group II (10 hyposalivation patients); group III (10 LVDO patients); and group IV (control, 13 healthy subjects). All individuals were tested for Candida-pseudohyphae form by direct examination and for Candida spp. culture growth in samples obtained from the retrocomissural, tongue's lateral border, and hard-soft palatal mucosa. RESULTS: Direct examination showed a statistically significant prevalence rate for pseudohyphae (p < 0.05) on the retrocomissural and on tongue's lateral borders of individuals with LVDO. A statistically significant (p < 0.05) culture growth for Candida spp. was found on the retrocomissural areas of those with hyposalivation and with LVDO, and on the palate mucosa and on the tongue's lateral borders in the smokers and in the individuals with LVDO when compared with those of the control group. CONCLUSION: While direct examination is effective for detecting pseudohyphae, LVDO and tobacco smoking seem to be factors of relevance to the development of CHC. CLINICAL SIGNIFICANCE: Since CHC has been linked to a high rate of malignant transformation, this study analyzes some clinical (and exogenous) factors that may contribute to the development of CHC and addresses some preventive measures to reduce its incidence.

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This article reports a case of oral mucosa lesions as the sole manifestation in Langerhans cell histiocytosis (LCH). This is a very uncommon manifestation of LCH since this disease preferably affects the bones with frequent involvement of the jaws. LCH may also involve other organs, particularly the lungs, liver, lymph nodes, and skin. The highlights of this report are the differential diagnosis, immunohistochemical analysis and, mostly, the therapeutic approach.

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Contact stomatitis associated with consumption of cinnamon flavoring agents is a relatively uncommon disorder. Of relevance, both clinical features and the histopathologic findings of this condition are nonspecific, and, more importantly, may resemble some other inflammatory oral mucosa disorders, eventually making diagnosis difficult. Usually a patient exhibits a combination of white and erythematous patches of abrupt onset, accompanied by a burning sensation. To shed some light on this subject, a case of a 64-year-old woman with hypersensitivity contact reaction on the oral mucosa due to cinnamon mints is presented, with emphasis on differential diagnosis and the process for confirmation of the diagnosis. The treatment consists of discontinuing the use of cinnamon products. Clinicians will be able to recognize this disorder following a careful clinical examination and detailed history. This recognition is important in order to avoid invasive and expensive diagnostic procedures.

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Rhabdomyomatous hamartoma is a rare disease that occurs predominantly in the skin. This paper describes a congenital lesion in a 17-year-old male, who came to our clinic presenting a circumscribed swelling involving the oral mucosa and vermillion border of the upper lip, purplish in color, and blanching under pressure. The patient reported that he had had lesion since his birth. A clinical diagnosis was of congenital haemangioma, and the patient was treated by photocoagulation using diode laser. When the lesion became smaller, by having its blood content reduced, the upper portion of the lesion was sliced off with CO2 laser and the tissue was sent for microscopic analysis. Histopathological examination showed an oral mucosa fragment with proliferation of striated muscle bundles admixed with small blood vessels, collagen, and nerve fibres. A supplementary analysis with immunohistochemistry demonstrated positivity for desmin, HHF35, smooth muscle actin, S-100, and CD34. Based on these findings, the lesion was diagnosed as rhabdomyomatous hamartoma. The aesthetic result has been very satisfactory after a 14-month followup.

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Lip and oral venous varices are acquired benign vascular lesions characterized by a darkblue to violaceous papule or nodule, commonly found on the ventral tongue and lower lip. Although these lesions are usually asymptomatic, they can bleed if injured. This study assessed the effectiveness of photocoagulation with high-intensity diode laser in the treatment of these lesions. Thirty-two patients (14 men and 18 women; mean age, 56 years) with lip and oral venous varices were examined and treated with a noncontact diode laser. With one exception, all cases were successfully treated with a single irradiation exposure session. Healing was complete in about 2 to 3 weeks; none of the patients experienced complications or recurrence. Photocoagulation with high-intensity diode laser was proven to be safe and effective for the treatment of lip and oral venous varices, with consistent results.

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The article reports a case of oral proliferative verrucous leukoplakia (OPVL) in a 76-year-old woman, underscoring how an otherwise inconspicuous white plaque lesion can rapidly turn into a phase of verrucous carcinoma and subsequently squamous cell carcinoma.

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Oral mucoceles are small-size, benign minor salivary gland pathologies. The most frequent localizations of these lesions are the lower lip mucosa. However, in some cases, they grow to an unusual size and hinder the preliminary diagnosis of mucocele. The purpose of this article is to report a case of a large oral mucocele with a diameter of 3.5 cm on the buccal mucosa of a 43-years-old male patient. The surgical procedure was carried out for a complete removal of the lesion.

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As infecções maxilofaciais são condições clínicas graves, de ocorrência relativamente comum,caracterizadas pela rápida disseminação do processo infeccioso aos tecidos adjacentes eespaços faciais da região de cabeça e pescoço. Sua causa é geralmente odontogênica. O objetivodeste estudo foi avaliar dados referentes às causas, características clínicas, manifestaçõesclínicas e eficácia do tratamento realizado em 42 pacientes admitidos com infecção maxilofacialno Departamento de Cirurgia Bucomaxilofacial do Hospital Tatuapé, São Paulo, no períodode março de 2005 a fevereiro de 2006. As infecções odontogênicas (83,30/0). com predomíniodas infecções periapicais, foram as principais causas das infecções maxilofaciais. As manifestaçõesclínicas mais comuns encontradas nos registros foram o edema acentuado (97,60f0), trismo(52,40f0) e prostração (47,60f0). Os pacientes diabéticos não compensados apresentaram tempode internação maior quando comparados ao dos pacientes não diabéticos (P = 0,001). Em 76,2%dos casos, o tratamento instituído foi a drenagem cirúrgica complementada por antibioticoterapiaendovenosa e remoção da causa. De acordo com o estudo realizado, pudemos concluirque houve predomínio de infecções maxilofaciais em adultos jovens, sendo as infecções odontogênicasas principais causas. O tratamento empregado foi efetivo na grande maioria dos casos.

Maxillofacial infections are severe clinical processes of relative occurrence characterizedbya rapid spreading of the infection into the neighboring tissues and to the fascial spaces ofthe head and neck region. Its cause is predominantly odontogenic. This study aimed to assess,retrospectively, data concern to the causes, clinical characteristics, clinical manifestations andtreatment efficacy in 42 in-patients with maxillofacial infection at the Department of Oraland Maxillofacial Surgery of Hospital Tatuapé, São Paulo, from March 2005 to February 2006.The odontogenic infections (mainly the periapical infections) accounted for 83.30f0 of the maxillofacialinfections. The most common clinical manifestations were exuberant edema (97.6%),trismus (52.40f0) and prostration (47.60f0). Uncontrolled diabetic patients showed a lonqer-recoveringperiod at the hospital when compared with that of nondiabetic patients (P = 0.001). In76.20f0 of the cases, the treatment proceeding was surgical drainage coupled with antibiotic intravenoustherapy and cause resolution. Summarizing the main findings, this study showed thatmaxillofacial infections occurred mostly in young-adults, with the odontogenic infections beingtheir principal cause. The providing treatment was effective in the great majority of the cases.

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