A 76-year-old woman presents for evaluation of a bothersome lesion of her left buccal mucosa. She neither smokes nor drinks alcohol. The growth was first noted approximately 2 weeks ago and is frequently traumatized when chewing. Examination reveals a firm, flesh-colored, 0.5cm papule.
Submit your diagnosis to see full explanation.
Oral fibromas are benign connective tissue neoplasms with focal fibrous proliferation due to trauma or local irritation. The lesions are characterized by granulation tissue and scar formation.1 Repeat trauma to the area results in a self-limiting hyperplasia of tissue that forms a fibrous mucosal mass.2 The most common location of oral fibromas is along the bite line of the buccal mucosa followed by the tongue, gingiva, and the lower labial mucosa.3
Patients will typically present with a firm papule of the buccal mucosa. Some patients complain of tenderness; most give a history of recurrent trauma to the site. These lesions can occur at any age, and the male-to-female ratio is approximately equal.4,5
The majority of lesions are readily diagnosed clinically. Histologic examination usually demonstrates fibrous hyperplasia along with keratinized epithelium and fibrous connective tissue stroma.3 Regression of the tumor may occur after removal of the stimulus. Treatment options include watchful waiting, surgical excision, electrocautery, and laser therapy. Although surgical excision is the treatment of choice, laser ablation is less traumatic and gaining in popularity. Recurrences may occur due to repetitive trauma at the site.2
Lauren Ax, MSPAC, PA-C, is a physician assistant on staff at the DermDox Center for Dermatology in Hazleton, Pennsylvania, and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.
1. Babu B, Hallikeri K. Reactive lesions of oral cavity: a retrospective study of 659 cases. J Indian Soc Periodontol. 2017;21(4):258-263.
2. Biswas S, Anuroopa P, Savita S. A report of solitary large buccal fibroma treated using diode laser: 6 month follow up. J Evolution Med Dent Sci. 2015;4(7):1278-1283.
3. Vidyanath S, Shameena PM, Johns DA, Shivashankar VY, Sudha S, Varma S. Reactive hyperplasic lesions of the oral cavity: a survey of 295 cases at a tertiary health institution in Kerala. J Oral Maxillofac Pathol. 2015;19(3):330-334.
4. Sangle VA, Pooja VK, Holani A, Shah N, Chaudhary M, Khanapure S. Reactive hyperplastic lesions of the oral cavity: a retrospective survey study and literature review. Indian J Dent Res. 2018;29(1):61-66.
5. Hunasgi S, Koneru A, Vanishree M, Manvikar V, Patil AM, Gottipati H. Retrospective analysis of the clinical features of 530 cases of reactive lesions of oral cavity.J Adv Clin Res Insights. 2014;1(1):1-6.