The Significance of Surface Ulceration as a Sign of Malignancy in Exophytic Oral Mucosal Lesions: Myth or Fact?

To compare the spectrum of pathologies in ulcerated versus non-ulcerated exophytic oral mucosal lesions and explore the significance of surface ulceration as an indication of malignancy. Retrospective analysis of exophytic lesions of the oral mucosa, 2009-2011. 713 biopsies of exophytic lesions of oral mucosa were included, of which 9. 4 % were ulcerated. Significant differences were found between ulcerated and non-ulcerated lesions. Of the ulcerated lesions 67. 2 % were reactive, 31. 3 % malignant and 1. 5 % benign, compared to 86, 8. 4 and 5. 6 % respectively in non-ulcerated lesions (p < 0. 0001). Malignancies were most prevalent in ulcerated lesions, in patients over 50. Malignancies presented the highest ulceration rate (36. 8 %, p < 0. 001), compared to reactive (7. 5 %) and benign neoplasia (1. 8 %), however, the majority of oral mucosal malignancies (63. 2 %) presented as non-ulcerated masses. Squamous cell carcinoma presented the highest ulceration rate among malignancies, but even these were only ulcerated in 50 % of cases. Non-epithelial malignancies were non-ulcerated in all cases. One-third of all malignancies were not suspected as such clinically, however, there was a better agreement between the clinical and microscopic diagnosis of malignancy in ulcerated lesions. Although the statistical likelihood of ulcerated masses to represent malignancy was higher than non-ulcerated lesions, especially in patients over 50, the majority of malignancies presented as non-ulcerated masses. Thus, all exophytic lesions should be submitted for microscopic analysis, and the status of ulceration should not be regarded neither as a factor in the decision to biopsy, nor a reliable indicator for malignancy.