Oral medicine: 2. ulcers: serious ulcers

A range of neoplasms may present with ulcers: most commonly these are carcinomas (Figure 1) but Kaposi sarcoma, lymphomas and other neoplasms may be seen and are discussed in Article 3. Biopsy is required to establish a definitive diagnosis.

A wide range of systemic diseases, especially, mucocutaneous diseases, blood, gut and miscellaneous uncommon disorders may cause oral lesions which, because of the moisture, trauma and infection in the mouth, tend to break down to leave ulcers or erosions. Biopsy is often required to establish the diagnosis.

Mucocutaneous disease that may cause oral erosions or ulceration (or occasionally blisters) include particularly Behçet's syndrome, and a number of skin diseases including lichen planus (Figure 2), occasionally erythema multiforme or pemphigoid, and rarely pemphigus.

Behçet's syndrome (BS) is a rare condition. It is the association of recurrent aphthous stomatitis (RAS) with genital ulceration, and serious eye disease (especially iridocyclitis) but other systemic manifestations may also be seen. The disease is found worldwide, but most commonly in people from the Eastern Mediterranean countries (particularly Greeks, Turks, Arabs and Jews) and along the Silk route taken by Marco Polo across eastern Asia, China, Korea and Japan.