Herpes

This visual ‘atlas’ will help you to identify and describe non-malignant, potentially malignant and malignant oral lesions.

A diverse range of mucosal lesions can occur in the oral cavity. The history and clinical presentation of the non-malignant conditions listed below will help you differentiate them from potentially malignant or cancerous lesions. However, occasionally this can be difficult. If a lesion is suspicious, refer your patient for biopsy and definitive diagnosis.

The stage when oral cancer is diagnosed is important, as it indicates prognosis. Stage I and II oral cancer corresponds directly to size, with no evidence of metastases. Stage III and IV oral cancer has spread to the lymph nodes or distant organs. Detection of oral cancer at an early stage can save your patient’s life.

Primary herpetic gingivostomatitis

Recurrent herpes labialis (cold sores)

Secondary infection with herpes simplex virus type 1 (HSV-1) that effects the vermillion of the lip with recurring sores following a pattern of slight paraesthesia, redness, appearance of vesicles, superficial ulceration, crusting and eventual healing over a period of 5 to 7 days. HSV-1 resides in the trigeminal ganglion latently after the initial primary infection, primary herpetic gingivostomatitis, that causes a widespread infection with fever, malaise, lethargy and widespread ulceration of the oral mucosa and gingivae over a period of 7 to 10 days. This primary infection mostly occurs in infants, when it is not as severe, but can be seen following oral sex in a seronegative young adult. Recurrent herpes labialis occurs in about 25-30% of individuals and is usually precipitated by concomitant illness, exposure to sunlight or wind and in immunocompromised individuals when it can become severe and prolonged.

Crusting ulcers on the right lower lip at the junction of the vermilion and skin that were previous vesicles that burst several days before this presentation.

Last updated: March 2021