Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




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"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1578 - 1581

A Clinical and Histopathological Study on the Oral Mucosal Lesions in Common Dermatological Disorders

Vippan Goyal, Ritesh Singla

1. Corresponding Author. 2. Assistant Professor Department of Opthalmology Adesh Medical College & Hosptial Bhatinda (Punjab), India.

Correspondence Address :
Vippan Goyal (Asst. Prof.)
Department of Dermatology
Adesh Medical College & Hosptial
Bhatinda (Punjab)
E-mail: vippangoyal@rediffmail.com

Abstract

Aims: To study the clinico-histopathological correlation of mucosal involvement in various dermatological disorders.

Background: The mucosa of the oral cavity is very important from the dermatologist’s point of view as it originates from the ectoderm. The structure and the lining of the oral cavity has importance in the diagnosis of oral as well as systemic diseases, as it is the site of various isolated mucosal lesions as well as mucosal lesions of systemic diseases. The physical examination is completed by doing a histo-pathological examination in order to establish a final diagnosis.

Material and Methods: 110 patients who had oral lesions, who were diagnosed clinically were included in the study. A 4-5 mm punch biopsy specimen of the oral lesion was taken under local anaesthesia and sent for histopathology.

Results: Of the 110 cases, Lichen planus and Pemphigus vulgaris formed a majority of the cases and the lips and the buccal mucosa were the most common sites which were reported.

Conclusion: From the ongoing discussion and observations, it can be concluded that for any disease which presents with oral manifestations or for diseases in which oral manifestations precede the systemic onset, especially of longer duration, the histopathology of the oral lesions should always be performed as it is an essential diagnostic tool.

Keywords

Clinical, Histo-pathology, Oral lesions, Dermatological disorders

How to cite this article :

Vippan Goyal, Ritesh Singla. A CLINICAL AND HISTOPATHOLOGICAL STUDY ON THE ORAL MUCOSAL LESIONS IN COMMON DERMATOLOGICAL DISORDERS. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Aug 24 ]; 5:1578-1581. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1578-1581&id=1731

INTRODUCTION
The oral mucous membrane is in direct continuity with the skin and it shares many of its functions; the specialized nature of the oral environment carries with it a distinct set of constraints for which adaptations are necessary. Because of this unique environment in the oral cavity, the disorders which affect the oral mucosa should be expected to be different from those of the skin, with respect to their incidence, clinico-pathologic manifestations, and the extent to which these factors are modified by the oral milieu. Most of the oral diseases which the clinicians encounter are readily understood and recognized when the observer begins with an appreciation of the basics of the oral structure and function. The oral cavity is the site of various mucosal lesions. Oral lesions are usually the result of local diseases, but they may be the early signs of systemic diseases which include dermatological disorders and in some instances, may cause the main symptoms (1). The physical examination is completed by doing a histopathological examination in order to establish a final diagnosis (2).

The mucosa of oral cavity is very important from the dermatologist’s point of view as it originates from the ectoderm (3). The structure and the lining of the oral cavity can assume importance in the diagnosis of oral as well as systemic diseases. The oral cavity should be examined in a systematic manner, starting with the lips, followed by the gingivobuccal sulcus, the buccal mucosa, gingiva, teeth, palates, tongue and the oropharynx. Histologically, the oral mucosa consists of stratified squamous epithelium, connective tissue stroma which is known as lamina propria and submucosa in all the areas, except for the gingiva and the hard palate (4). In the non-keratinized regions such as the buccal (cheek) and the floor-of-mouth mucosae, overt keratinization and granular cells areabsent and the surface cells are flattened, with elongated nuclei (5). The stratified squamous epithelium is non-keratinized. The submucosa is a loose connective tissue layer which helps in the attachment of various structures. The blood vessels, accompanied by the lymphatics,course through the submucosa. The oral mucosa contains the same population of dendritic cells as the skin: melanocytes, Langerhans cells and Merkel’s cells. The diseases of the oral mucosa may be a part of the general systemic disease or a component of cutaneous disease or they may be limited to the oral cavity itself. The interpretation of the symptoms and signs poses a difficulty because of the anatomical and functional peculiarities of the oral mucosa. The papular lesions are covered by stratified squamous epithelium and they appear to be moist. The vesicular lesions always rupture readily to leave a raw, eroded surface. The ulcers are easily infected and are consequently foul smelling. A biopsy of the suspicious areas of the oral cavity often requires the cooperative effort of the dermatologist and the pathologists (6).

To the best of our knowledge, not many reports of such studies have been reported, especially from this part of the country. Therefore, we undertook this open, randomized case control study to evaluate the clinico-histopathological correlation in the mucosal involvement in various dermatological disorders.

Material and Methods

110 patients were selected from the skin clinic in the Malwa region of Punjab from 2008 to 2010 to study the clinico-histopathological correlation of various causes of oral lesions. The patients’ diagnoses were made on the basis of the clinical findings. A detailed history and relevant investigations were recorded in the proforma. All the patients were informed about the mucosal biopsy and theirconsent was recorded. Before the procedure was undertaken, the characteristics of the lesion (number, size, shape, colour, texture, consistency, the time of evolution, associated signs and symptoms and regional nodes) were described in the patients’ clinical records, together with a presumed diagnosis and a possible differential diagnosis. After the surgical preparation of the lesion from where the biopsy was taken, an amide-type local anaesthetic with a vasoconstrictor (2% Xylocaine with adrenaline) was given. A 4-5 mm punch biopsy was then taken. The specimen was introduced in the fixing solution i.e. 10% formalin solution and this sample was sent for histopathology. Firm pressure for haemostasis was given and the incised area, if needed, was closed with non-absorbable sutures to facilitate healing. The sutures were removed after 6-8 days. Although no dressing was applied following the biopsy, the postoperative care consisted of antibiotics and anti-inflammatory agents which were given for 7-10 days. The clinical diagnosis was correlated with the pathological findings and any dissociation between the two was recorded.

Results

The male to female ratio was 1:1.2, and a peak incidence was observed in the age group of 31-50 years. Out of these 110 cases; 47(42.73%) were diagnosed clinically as Lichen planus; 32(29.09%) were Pemphigus vulgaris; 12(10.91%) were discoid lupus erythematosus (DLE); 17(15.45%) were recurrent aphthous ulcer and 2(1.81%) were leukoplakia, as shown in (Table/Fig 1). The duration of the diseases ranged between 15 days to 10 years, with a maximum number of cases (58.18%) having less than 6 months duration, as shown in (Table/Fig 2). 39.09% cases had reticular type of lesions and 31.82% had ulcerative lesions, as shown in (Table/Fig 3). Multiple sites were involved in 56% of the patients and the buccal mucosa and the lips were affected most commonly. In 42% of the cases, skin involvement was there. The histopathological features are as shown in (Table/Fig 4). In 102(92.73%) cases, a clinico-histopathological correlation was present, as shown in (Table/Fig 5). In the present study, the diseases which were encountered were Lichen planus- 47 (42.73%) cases; Pemphigus vulgaris -32 (29.09%) cases; recurrent aphthous ulcer -17 (15.45%) cases; DLE- 12 (10.91%) cases; and leukoplakia - 2 (1.81%) cases. Skin involvement was present in 42% cases. It was observed that the most frequent oral conditions in the dermatological clinic were Pemphigus vulgaris (18.3%), Lichen planus (8.3%), candidiasis (8.3%), recurrent aphthous ulcers (6.7%), herpetic lesions (6.7%), xerostomia (6.7%), and traumatic lesions (6.7%). Oral affection in the muco-cutaneous conditions was observed in 21 (35%) patients; the diagnosis was based on oral signs in 10 (48%) of these patients (15).

Discussion

The structure and the lining of the oral cavity have importance in the diagnosis of oral as well as systemic diseases. The oral lesions in general, are very common. Some are ominous while most are not; the clinician therefore, is continually faced with diagnostic challenges. The correct diagnosis of oral lesions requires attention to the history, physical findings, laboratory examinations, and histopathological examinations in almost equal measure.

The nonmalignant, ulcerous diseases of the oral cavity often require repeated histological and clinical observations to establish a diagnosis (2). It was observed that punch biopsy of the oral cavity was a safe and useful technique that could be easily employed by dermatologists (7). The accurate diagnosis of chronic oralulcers requires a peri-lesional biopsy (8). The biopsy is required to establish the diagnosis and the histopathological examination must be coordinated with the clinical findings (9). The histological examination confirms the diagnosis and it helps to formulate a prognosis and to allow the commencement of the treatment (10).

As observed in the present study, the male to female ratio was 1:1.5 and the age varied from a minimum of 13 years to a maximum of 72 years, with a peak incidence between the ages of 31 and 50 years. The mean age group which was affected in males was 38.95 years and in females, the mean age group which was affected was 41.03 years. In oral lichen planus, women out-numbered men by more than two to one. The mean age group at which the lesion was discovered was the sixth decade of life (11). Pemphigus vulgaris was more frequent among women (9:3), and there was a tendency for the severity and frequency of the disease to decrease with time (12). The ages of the patients ranged from 27 to 79 years; the mean age was 56.5 years (13). In oral lupus erythematosus, women outnumbered men, with a mean age of 46 years (14).

As observed in the present study, the most frequent location of the oral lesions was buccal mucosa, followed by the lip. The most frequent type of lesion was reticular, followed by an ulcerative pattern. Oral lichen planus was found mainly in women and most commonly on the buccal mucosa (16). The most common pattern which was found was reticular or papular, which was predominantly located on the buccal mucosa, the gingiva, and the borders of the tongue (17).

In 92.73% cases, the clinical diagnosis was confirmed by histopathological examination. The histopathological analysis showed that two cases which were clinically diagnosed as oral lichen planus were in fact, benign keratosis. In these cases, the lesion appeared to be hyperpigmented and unilaterally located and it had a reticular pattern, and therefore it was diagnosed as OLP. This finding led to the conclusion that abiopsy should always be done. In one case with a clinical diagnosis of Pemphigus vulgaris, the histopathological diagnosis revealed ulcerative stomatitis. In this case, the surface erosion existed, with the destruction of the epithelium. In one case with a clinical diagnosis of recurrent aphthous ulcer, the histopathological diagnosis was ulcerative stomatitis. In this case, the lesion presented an erythematous surface with a white lesion, from which a part of the biopsy was taken. In the present study, the correlation between the clinical and the histological diagnoses was missing in 4 cases. This finding suggests that in the diagnosis of oral lesions, we cannot rely on a clinical or histological diagnosis alone. Also, we think that the clinical diagnosis was not confirmed in these cases because the biopsy specimens were inadequate, exhibiting only an ulcerated surface. The biopsy of lesioned tissues can be challenging. Biopsy specimens of predominantly erythematous and ulcerated mucosal lesions should be taken a few millimeters away from the ulcers, sothat the specimen’s epithelium and connective tissue remain intact (18). It has been suggested that punch biopsies provide greater interobserver reliability than wedge biopsies in the histopathological diagnosis (19).

The difference in the clinical and histopathologic diagnoses might be partly caused by the fact that the clinical information did not accompany the biopsy specimen and that the pathologist was not aware of the clinical presentation and the exact location of the lesion. In 213 cases of oral lichen planus which were correlated clinico-pathologically, in spite of considerable variabilities in both the aspects; it was observed that there was a clinical and histopathological agreement in 96% cases (20). In 51 cases of subepidermal bullous disease which were correlated clinicopathologically, it was observed that there was a good clinicopathologic correlation, with 46 out of 51 cases showing concordant clinical and histological diagnoses (21). In the clinico-pathological discordance for lesions of the oral mucosa, it was observed that the statistical analysis demonstrated 17 cases of agreement (81%) and 4 cases of discordance (19%) between the clinical diagnosis and the pathological diagnosis (22). It is of interest that the early phase of these lesions usually exhibits an interface lymphocytic infiltrate that may mimic an oral lichenoid stomatitis such as Lichen planus. It is therefore important to follow-up any patient with oral leukoplakia and those who were diagnosed with non-specific lichenoid stomatitis closely (23).

Conclusion

The discrepancy between the clinical and histopathological diagnoses in 7.27% of the cases suggests that all cases of oral mucosal lesions should be submitted for a histopathological analysis. However, histopathology is also mandatory for predicting the prognosis in these patients.

References

1.
Scully C. The Oral Cavity and Lips. In: Burns T, Breathnach SM., Cox N, Griffiths C editors. Rook’s Textbook of Dermatology, 7th ed. 2004; 66.1-66.20.
2.
Posawetz W, Jakse R, Soyer P. Differential diagnosis of ulcerative mucous membrane diseases of the mouth cavity and the pharynx. Laryngorhinootologie. 1990 Feb; 69(2): 80-3.
3.
Ten Cate AR. Oral Histology. St. Louis, Missouri: CV Mosby, 2nd ed., 1985.
4.
Prime SS. The development, structure and function of the oral mucosa. In: Scully C, editor. The Mouth in Health and Disease. Oxford: Heinemann Medical, 1989; 124-44.
5.
Hume WJ, Potten CS. Advances in epithelial kinetics-an oral view. J Oral Pathol 1979; 8: 3-22.
6.
Janaki VR, Thomas J. Disorders of the oral cavity and the mucous membrane. In: Valia RG, Valia AR, Siddappa K, editors. IADVL: Textbook and Atlas of Dermatology 2nd ed., 2001; 2: 1121.
7.
Eisen D. The oral mucosal punch biopsy: A report of 140 cases. Arch Dermatol. 1992 Jun; 128 (6): 815-7.
8.
Chiang H, Sirios DA, Bielory L. Chronic oral mucosal ulceration in a 54-year-old female. Ann Allergy Asthma Immunol. 2000 Apr; 84(4): 391-5.
9.
Firth NA. Oral lesions with a papillary surface texture: clinical and pathological correlations. Ann R Australas Coll Dent Surg. 2000 Oct; 15: 111-5.
10.
Szpirglas H. Diagnosis of mouth ulcers. Rev Prat. 2002 Feb 15; 52(4): 375-9.
11.
Brown RS, Bottomley WK, Puente E, Lavigne GJ. A retrospective evaluation of 193 patients with oral lichen planus. J Oral Pathol Med. 1993 Feb; 22(2): 69-72.
12.
Robinson JC, Lozada-Nur F, Frieden I. Oral pemphigus vulgaris: A review of the literature and a report on the management of 12 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Oct; 84(4): 349-55.
13.
Davenport S, Chen SY, Miller AS. Pemphigus vulgaris: clinicopathologic review of 33 cases in the oral cavity. Int J Periodontics Restorative Dent. 2001 Feb; 21(1): 85-90.
14.
Togliatto M, Carrozzo M, Conrotto D, Pagano M, Gandolfo S. Oral lupus erythematosus. Description and analysis of 11 cases. Minerva Stomatol. 2000 Jan-Feb; 49(1-2): 35-40.
15.
Ramirez-Amador, Velia A, Esquivel-Pedraza, Lilly DDS, Orozco-Topete, Rocio MD. Frequency of oral conditions in a dermatology clinic. International Journal of Dermatology July 2000; 39(7): 501-505.
16.
Silverman S Jr, Gorsky M, Lozada-Nur F, Giannotti K. A prospective study of the findings and management in 214 patients with oral lichen planus. Oral Surg Oral Med Oral Pathol. 1991 Dec; 72(6): 665-70.
17.
Bornstein MM, Kalas L, Lemp S, Altermatt HJ, Rees TD, Buser D. Oral lichen planus and malignant transformation: a retrospective follow-up study of clinical and histopathologic data. Quintessence Int. 2006 Apr; 37(4): 261-71.
18.
Lynch DP, Morris LF. The oral mucosal punch biopsy: indications and technique. J Am Dent Assoc. 1990 Oct; 121(4): 452-454.
19.
Fischer DJ, Epstein JB, Morton TH, Schwartz SM. Inter-observer reliability in the histopathologic diagnosis of oral pre-malignant and malignant lesions. J Oral Pathol Med 2004; 33: 65-70.
20.
McClatchy KD, Silverman S, Hansen LS. Studies on oral lichen planus: clinical and histopathological correlation in 213 patients. Oral Surg. 1975; 39: 122-129.
21.
Saxe N, Kahn LB. Sub-epidermal bullous disease: A correlated clinicopathologic study of 51 cases. J Cutan Pathol. 1976; 3(2): 88-94.
22.
Benyahya I, Maaroufi A, Jabri L, Haddou G. Clinico-pathological discordance for lesions of the oral mucosa. Rev Stomatol Chir Maxillofac. 2004 Sep; 105(4): 211-4.
23.
Mete O, Keskin Y, Hafiz G, Kayhan KB, Unur M. Oral proliferative verrucous leukoplakia: Underdiagnosed oral precursor lesion that requires a retrospective clinicopathological correlation. Dermatol Online J. 2010 May 15;16(5):6.

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