What is the diagnosis and treatment for a kissing lesion (a type of mucosal lesion)?

From the Guidelines

The diagnosis and treatment of a kissing lesion, a type of mucosal lesion, should prioritize the use of sodium bicarbonate containing mouthwash, analgesics, and topical corticosteroids, as suggested by expert opinion in the management of oral and gastrointestinal mucosal injury 1. When considering the diagnosis of a kissing lesion, it is essential to identify the underlying cause, which can range from infectious to inflammatory conditions. The treatment approach should be tailored to address the primary condition.

• For infectious causes, antiviral medications or antibiotics may be prescribed, depending on the specific pathogen involved.
• For inflammatory conditions, topical corticosteroids, such as dexamethasone mouth rinse (0.1 mg/ml) or clobetasol gel/ointment (0.05%), can be considered to reduce inflammation and promote healing 1.
• The use of sodium bicarbonate containing mouthwash is recommended to prevent and treat stomatitis, with the frequency of rinsing increased as necessary up to every hour 1.
• Analgesics, such as anesthetic mouthwashes (viscous lidocaine 2%) or systemic analgesics, may be provided to manage pain from stomatitis, following the WHO pain management ladder 1. It is crucial to treat both lesions simultaneously to prevent reinfection or continued inflammation, and to keep the affected areas clean, dry, and separated when possible to promote healing.
• The mechanism behind kissing lesions involves direct contact transmission of pathogens or inflammatory mediators from one surface to another, with the pattern of lesions reflecting the anatomical relationship between the affected surfaces.
• Other treatments, such as coating agents, topical anesthetics, and alternative mouthwashes, may be considered to treat stomatitis, as suggested by expert opinion 1.

From the Research

Diagnosis of Kissing Lesions

• A kissing lesion, specifically a mucosal lesion, can be challenging to diagnose, especially in delicate anatomical locations such as the vulva or labia majora 2.
• Careful physical examinations are mandatory to diagnose kissing lesions, and mechanical irritation in the genital area can be an additional reason for choosing a surgical-reconstructive therapeutic option 2.
• A biopsy can be taken to rule out malignancy, and immunohistochemistry can be performed with specific melanocyte markers to confirm the benign origin of the lesion 2.

Treatment of Kissing Lesions

• The surgical approach is not always the preferred one, but it is the one that could lead to a definitive solution to the problem 2.
• Surgical excision can be advised for prevention, but the approach should be based on lesion size and location, proximity and involvement of key anatomical landmarks, as well as individual characteristics 3.
• Local flaps or grafts can be utilized in surgical management, often requiring multiple interventions 3.
• Fluoroscopically-guided injections can provide pain relief in patients with "kissing spine" disease or Baastrup's sign 4.

Specific Considerations

• Atypical melanocytic nevi of genital type can be considered as melanoma precursors, and lesions that occupy a larger area can be particularly problematic 2.
• Kissing lesions can occur in various locations, including the talotibial joint, where subchondral bone contusions and fractures can occur after a sprain of the ankle 5.
• The kissing balloon-stent technique can be used for simple bifurcation lesions in coronary angiography 6.