During a routine clinical examination, differentiating benign from malignant oral lesions relies on careful assessment of lesion characteristics and patient risk factors. Key features suggestive of malignancy include lesions that are persistent (lasting more than 3 weeks), non-healing, indurated, ulcerated, or exhibiting irregular borders and rapid growth NICE NG12. Malignant lesions may also present with pain, bleeding, or fixation to underlying tissues, whereas benign lesions are often asymptomatic and stable in size Yuhan et al. 2018. Colour changes such as erythroplakia (red patches) or leukoplakia (white patches) that do not resolve warrant suspicion NICE NG12. Additionally, malignant lesions may show surface nodularity or verrucous changes, while benign lesions tend to have smooth, well-defined margins Yuhan et al. 2018. Palpation is important to detect induration or fixation, which are more typical of malignancy NICE NG12. Patient history including tobacco or alcohol use, age over 40, and previous head and neck cancers increase suspicion of malignancy Yuhan et al. 2018. Referral for urgent specialist assessment is indicated if malignancy is suspected based on these clinical features NICE NG12.
In summary, a systematic approach combining lesion appearance, duration, symptoms, and patient risk factors helps differentiate benign from malignant oral lesions during routine examination, guiding timely referral and management NICE NG12; Yuhan et al. 2018.