Vesiculobullous disease

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.

Pemphigus vulgaris

Pemphigus vulgaris is the most common autoimmune intra-epithelial bullous disease that is also potentially life-threatening. It causes blisters on the skin and/or mucosa. Although this is a rare condition, the mouth is affected in about 90% of people and in some patients it will be the only site affected. Accompanying oral lesions are poorly defined, irregular persistent ulcers.

Extensive painful erythema, ulceration and deflated bullae across the soft palate in this patient with pemphigus vulgaris.

Mucous membrane pemphigoid

A rare mucosal autoimmune sub-epithelial blistering disease, with a wide variation in severity: from mild, almost painless oral ulceration, to severe blisters with scarring affecting the mouth, larynx, oesophagus and conjunctiva which can lead to blindness.

Painful ulceration across the left buccal mucosa surrounded by bright erythema

Deflated bullae that has ulcerated with surrounding erythema on the right lateral margin of the tongue in the same patient as imaged above.

Last updated: March 2021