Bryan Trump, DDS recaps his lecture High Risk Patterns and Locations for Oral Lesions on Thursday, November 9, 2023, at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, CA.

In this video

In this interview with nurse practitioner Veronica Richardson, Dr. Trump — an associate professor and maxillofacial pathologist at the University of Utah School of Dentistry — tackles what he calls the "black hole" of the oral cavity for dermatology providers. He starts with leukoplakia, the most common intraoral lesion: white, thickened areas that don't rub off and have no obvious cause. Because these are "pre-cancerous until proven otherwise," his standard of care is to inform the patient, explain what it is, and recommend a biopsy — "when in doubt, biopsy." For oral lichen planus, he stresses looking for symmetry (left buccal mucosa should match right), and flags the high-risk sites for oral cancer as the lateral tongue, ventral tongue, and floor of mouth, where a lichen planus mimicker should raise concern.

Dr. Trump also gets practical about treatment. For widespread symptomatic lichen planus he reaches for a dexamethasone elixir rinse (0.5 mg/5 mL), held — not swished — in place for five minutes so the medicine reaches beneath the surface, two to three times a day with drug holidays when comfortable. For isolated stubborn spots he prefers clobetasol 0.05% gel, applied to dried tissue for better absorption. He closes on salivary gland tumors, which present as painless, slow-growing masses most often on the lateral hard palate, and on referral timing: make the referral right away, but a few weeks' wait won't change outcomes in most cases.

  • Leukoplakia is white, thickened tissue that doesn't rub off with no clear cause — treat it as "pre-cancerous until proven otherwise" and recommend biopsy.
  • With oral lichen planus, look for symmetry; the lateral tongue, ventral tongue, and floor of mouth are high-risk sites for oral cancer, so biopsy to rule out a mimicker.
  • For widespread disease, use a dexamethasone elixir rinse held in place five minutes (don't swish — it stimulates saliva and dilutes the medicine); for isolated spots, clobetasol 0.05% gel on dried tissue.
  • Once patients are stable, space follow-ups to annual visits, and rebiopsy anytime a lesion spreads, appears in a new location, or loses its Wickham striae web pattern.
  • Salivary gland tumors are usually painless, slow-growing bumps, most commonly on the lateral hard palate — refer any suspicious mass right away, though a few weeks to biopsy won't change most outcomes.