White and red lesions
Assess site, homogeneity, wipeability, risk factors and change. A persistent non-wipeable lesion needs a diagnostic plan rather than a colour label alone.
Understand
Wipeability, site, symmetry, texture and associated inflammation help distinguish candidal coating, keratosis, lichen planus and potentially malignant lesions. Red lesions often warrant particular concern.
Assess
Document exact distribution, risk factors and change. Assess whether a white patch can be scraped off and whether there is a mixed red component or induration.
Apply
Investigate persistent unexplained lesions appropriately and arrange review even after reassuring histology. A visual label such as leukoplakia does not establish a microscopic diagnosis.
Key distinctions
White lesions may be keratotic, inflammatory, infective or neoplastic; red lesions can be inflamed or atrophic but also carry malignant potential. The mixed red-white pattern, texture and focal induration help decide biopsy site. Clinical labels describe appearance and should be replaced by a specific diagnosis when histology and context allow it.
Think through a case
A bilateral lacy white pattern differs from a solitary indurated red-white plaque. The latter needs a more urgent diagnostic plan even if both are initially called “white lesions”.
The distinction to remember
Do not use wipeability or colour alone as a final diagnosis; palpation, distribution and duration matter.
Test your recall
Which generally deserves greater concern: a red patch or a simple wipeable coating?
Show answer
An unexplained persistent red patch.