Differential Diagnosis for Earth Mattis Patches with Bluish White Centers on Lingual and Buccal Mucosa

• Single Most Likely Diagnosis
  • Lichen planus: This condition is known for causing white, lacy patches on the mucous membranes inside the mouth, including the lingual and buccal mucosa. The bluish tint could be due to the inflammatory nature of the disease.
• Other Likely Diagnoses
  • Leukoplakia: A condition where thick, white patches or lesions appear on the tongue, the inside of the cheeks, or on the floor of the mouth, sometimes with a bluish tint due to underlying vascular changes.
  • Oral candidiasis (thrush): Although typically associated with a white, cottage cheese-like appearance, some forms of oral candidiasis can present with bluish white patches, especially if there's an underlying condition affecting the mucosa.
• Do Not Miss Diagnoses
  • Oral cancer: Although less likely, any unusual lesion or patch in the mouth, especially those with atypical colors or textures, should prompt consideration of oral cancer due to its potential severity and the importance of early detection.
  • Lupus erythematosus: Oral lesions can be a manifestation of systemic lupus erythematosus, and while less common, they can present in various forms, including those that might resemble the described patches.
• Rare Diagnoses
  • Pemphigus vulgaris: An autoimmune disease that can cause blistering of the skin and mucous membranes, including the mouth. The lesions can sometimes appear as bluish white patches after the blisters rupture.
  • Chronic graft-versus-host disease (GVHD): In patients who have undergone bone marrow or stem cell transplants, GVHD can cause a variety of oral manifestations, including lichenoid changes and mucosal lesions that might fit the description.