Geographic Tongue

Geographic tongue is a relatively common idiopathic condition typically characterised by migrating areas of depapillation on the dorsum of the tongue [6]. In many cases it is associated with fissuring. There is loss of filiform papillae often surrounded by a slightly raised yellowish-white and crenellated margin. These areas of depapillation tend to heal centrally and spread cen-trifugally. Occasionally, the ventrum is involved and in that site lesions consist of an area of erythema completely or partially surrounded by a circinate whitish halo. Identical lesions can occasionally be seen elsewhere in the mouth and have been called "ectopic geographical tongue", although geographical stomatitis or benign migratory stomatitis would be more appropriate terms [81]. The majority of cases of geographical tongue are painless, but some patients complain bitterly of soreness and discomfort, which may or may not be associated with specific foods.

Geographical tongue is usually obvious clinically and is rarely biopsied. However, it has very typical microscopical features [114]. There is loss of filiform papillae and typically only a mild chronic inflammatory

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Fig. 3.11. Geographical tongue (erythema migrans) showing polymorphonuclear leukocyte microabscesses in the epithelium

shredded, often patchily erythematosus white plaques limited to areas accessible to chewing. In typical fric-tional keratosis microscopy usually shows a thick ortho-keratinised layer with a prominent granular cell layer. There is no significant dysplasia and inflammation of the underlying corium may be minimal in the absence of ulceration. In keratosis due to habitual chewing there is often acanthosis and the surface is usually irregular and parakeratinised. It frequently shows a covering of adherent basophilic cocci or more dense bacterial conglomerates.

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