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JAMA Dermatology Clinicopathological Challenge
December 2018

A White Patch on the Tongue

Author Affiliations
  • 1Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia
  • 2Section of Oral and Maxillofacial Pathology, Division of Dermatopathology, Department of Dermatology, University of Pennsylvania Health System, Philadelphia
JAMA Dermatol. 2018;154(12):1475-1476. doi:10.1001/jamadermatol.2018.1571

An 80-year-old white woman presented with an asymptomatic white patch affecting the tongue of 1 month’s duration. She had a 15-year history of oral lichen planus (OLP) managed with betamethasone dipropionate, 0.05%, gel twice daily and clotrimazole troches, 10 mg, 3 times daily as needed for symptomatic OLP flares. Medical history revealed stage 1A mycosis fungoides/cutaneous T-cell lymphoma affecting the right calf and left thigh managed primarily with halobetasol, 0.05%, cream owing to intolerance of narrowband UV-B therapy and mechlorethamine, 0.016%, gel. Immunosuppression or history of infectious diseases, including human immunodeficiency virus (HIV), was not reported. A 1.5 × 1.0-cm nonremovable white, plaquelike lesion was observed on the left lateral tongue (Figure 1A). Biopsy specimens were obtained with a 3-mm punch instrument at 3 different sites, which demonstrated similar microscopic findings (Figure 1B and C).

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