Metastatic Neoplasms to the Oral Cavity Differential Diagnoses

Updated: Jun 26, 2018
  • Author: Abraham Hirshberg, MD, DMD; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Diagnostic Considerations

Misdiagnosis of a metastatic lesion as a benign reactive lesion may delay diagnosis and treatment. Metastatic tumors should always be considered in the differential diagnosis of benign-looking lesions in the oral cavity, especially in patients with a previous history of a malignant disease. Biopsy is mandatory to establish an accurate diagnosis.

For oral soft tissues, consider the following:

  • Pyogenic granuloma
  • Peripheral giant cell granuloma (only in the gingiva)
  • Fibrous epulis (only in the gingiva)
  • Malignant primary tumor (oral cancer, including salivary gland tumor)

For the jawbone (differential diagnosis depends on location), consider the following:

  • Malignant tumors (eg, primary intraosseous carcinoma, other malignant odontogenic tumors)
  • Central malignant salivary gland tumors
  • Sarcoma (eg, malignant fibrous histiocytoma, fibrosarcoma)

Bony lesions can mimic benign lesions (some cases), as follows:

  • Periapical pathology
  • Infected odontogenic cyst or tumor
  • Osteomyelitis

For fumb lips or chin, [29]  consider the following:

  • Odontogenic - Dental infection, dental local anesthesia, facial trauma, dental trauma, osteomyelitis, benign local tumors
  • Systemic - Amyloidosis, sarcoidosis, sickle cell anemia, syphilis, vasculitis, aneurysms, multiple sclerosis, HIV disease, diabetes mellitus
  • Nonmetastatic neurological manifestation of malignancy

Differential Diagnoses