Differential Diagnosis for a White Raised Lesion on the Mouth that Feels Pebble-Like

Single Most Likely Diagnosis

• Fordyce spots: These are small, white or yellowish bumps on the lips, inside of the cheeks, and sometimes on the genitalia. They are caused by the abnormal presence of sebaceous glands in the mucous membranes and are usually harmless. The pebble-like texture described could be consistent with the appearance of Fordyce spots, especially if they are numerous and clustered.

Other Likely Diagnoses

• Oral leukoplakia: This condition presents as a white patch or plaque that cannot be rubbed off and is often associated with chronic irritation or tobacco use. While it doesn't typically feel pebble-like, some variants could present with a more nodular appearance.
• Lichen planus: An inflammatory condition that can affect the mucous membranes inside the mouth, leading to white, lacy patches; red, inflamed tissues; or open sores. The lesions can sometimes feel rough or pebble-like, especially in the more advanced or atrophic forms.
• Mucous cyst (mucocele): A mucous cyst can appear as a raised, usually painless, lesion that can have a bluish or whitish color. It's caused by the accumulation of mucin from a ruptured salivary gland duct. While not typically described as pebble-like, larger cysts could have a varied texture.

Do Not Miss Diagnoses

• Squamous cell carcinoma: Although less common, any unusual oral lesion, especially in individuals with risk factors like tobacco use or excessive sun exposure, warrants consideration of oral cancer. Early lesions can be white and raised, and while they might not typically feel pebble-like, any new or changing lesion should be evaluated for malignancy.
• Leukemia or lymphoma: In rare cases, systemic diseases like leukemia or lymphoma can manifest with oral lesions, including white, raised patches or nodules. These conditions are critical to identify early due to their potential for severe outcomes if left untreated.

Rare Diagnoses

• Oral histoplasmosis: A fungal infection that can cause a variety of oral lesions, including white, raised patches, especially in immunocompromised individuals.
• Tuberculosis: Oral tuberculosis can present with a range of lesions, including ulcers, patches, or nodules. While rare, it's an important consideration in patients with known tuberculosis or those from endemic areas.
• White sponge nevus: A rare, benign condition that affects the mucous membranes, causing white, spongy patches. It's usually present from birth or appears during childhood.

Each of these diagnoses has distinct characteristics, and a thorough clinical examination, possibly supplemented by biopsy or other diagnostic tests, is necessary to determine the exact cause of a white, raised, pebble-like lesion on the mouth.