Differential Diagnosis for Small Red Tongue Lesion

Single Most Likely Diagnosis

• Traumatic ulcer: This is the most likely diagnosis due to the frequent bleeding and location in the middle of the tongue, which is a common site for accidental bites or trauma while eating or speaking.

Other Likely Diagnoses

• Erosive lichen planus: This condition can cause red, painful lesions on the tongue that may bleed, especially if the patient has a habit of biting or rubbing the area.
• Geographic tongue: Although typically painless, geographic tongue can sometimes cause red, bleeding lesions, especially if the patient has a superimposed traumatic injury.
• Aphthous ulcer: Also known as canker sores, these can appear as small, red, bleeding lesions on the tongue, often due to minor trauma or stress.

Do Not Miss Diagnoses

• Squamous cell carcinoma: Although less likely, it's crucial to consider oral cancer, especially if the lesion is persistent, growing, or has an unusual appearance. Bleeding can be a symptom of advanced disease.
• Angina bullosa hemorrhagica: This condition involves sudden, painless bleeding into the oral mucosa, which could present as a small, red, bleeding lesion on the tongue.

Rare Diagnoses

• Granuloma: A rare possibility, granulomas can occur on the tongue and may appear as red, bleeding lesions, although they are more commonly associated with other symptoms.
• Kaposi's sarcoma: In immunocompromised patients, Kaposi's sarcoma can manifest as red, bleeding lesions in the oral cavity, including the tongue.
• Erythema multiforme: A rare condition characterized by target lesions, which can sometimes appear on the tongue and may bleed, especially if there is mucosal involvement.