Differential Diagnosis for Oral Lesions

The patient presents with non-vascular lesions that are 2 to 10 mm in size, scattered in the oral fairness and mouth. Here is a differential diagnosis based on the provided information:

• Single Most Likely Diagnosis

  • Oral Mucosal Candidiasis: This condition is characterized by small, white lesions in the mouth, which can be scattered and vary in size. It's a common condition, especially in immunocompromised patients or those with poor oral hygiene.

• Other Likely Diagnoses

  • Recurrent Aphthous Stomatitis (RAS): Also known as canker sores, these are small, painful ulcers that can appear in the mouth. They are common and can be triggered by stress, trauma, or certain foods.
  • Fordyce Spots: These are small, yellowish or white bumps on the lips, inside of the cheeks, and sometimes the genital area. They are benign and very common, representing ectopic sebaceous glands.
  • Oral Lichen Planus: This is a chronic inflammatory condition that can cause white, lacy patches; red, inflamed tissues; or open sores in the mouth. It can be associated with certain medications or conditions.

• Do Not Miss Diagnoses

  • Oral Cancer: Although less likely given the description of non-vascular lesions, any oral lesion, especially those that are persistent or changing, should prompt consideration of oral cancer. Early detection is crucial for treatment outcomes.
  • Infectious Diseases (e.g., Herpes Simplex, Hand-Foot-and-Mouth Disease): Certain infectious diseases can cause oral lesions. Identifying these conditions is critical for appropriate treatment and prevention of spread.

• Rare Diagnoses

  • Pemphigus Vulgaris: A rare autoimmune disease causing blistering of the skin and mucous membranes. Oral lesions can be the first sign.
  • Erythema Multiforme: A skin condition characterized by target lesions, which can also affect the mucous membranes, including the mouth.
  • Oral Hairy Leukoplakia: Typically seen in immunocompromised patients, especially those with HIV/AIDS, this condition presents as white patches on the sides of the tongue.

Each of these diagnoses has distinct characteristics, and a thorough examination, including history taking and possibly biopsy for persistent or suspicious lesions, is necessary for an accurate diagnosis.