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Oral Mucosal White Lesions

Year 2019, , 670 - 683, 30.09.2019
https://doi.org/10.17098/amj.624695

Abstract

Oral
mucosal lesions are common pathologies in dentistry, otolaryngology and
dermatology outpatient clinics. Oral mucosal lesions could either be
infectious, autoimmune, premalignant or malignant, or ocur secondarily in the
form of oral involvement of a systemic disease. Therefore, early diagnosis and
treatment of oral mucosal lesions are important. The white lesions of the oral
mucosa may be smooth- surfaced and may appear in the form of focal, multiple or
diffuse foci, located at the same level with the solid mucosa. In addition, they
may be located slightly raised, hairy, folded, or of lace appearance. These
lesions may become fissured, ulcerative, erosive or inflammatory lesions in the
future.

With detailed patient examination and anamnesis, most of the oral mucosal white
lesions can be diagnosed and the necessary treatment can be applied. Clinical
findings provide important clues about the origin and diagnosis of the lesion.
Early diagnosis and appropriate approaches of oral lesions will yield positive
results in the prognosis of diseases and the quality of patients’ lives.
Therefore, the findings of oral lesions, oral findings of systemic diseases,
malignancy potential of lesions should be evaluated. The aim of this review is
to examine the oral mucosal white lesions in detail, to evaluate the current
approaches and increase the awareness of the dentists and pediatric dentists.

References

  • Said S, Golitz L. Vesiculobullous eruptions of the oral cavity. Otolaryngologic Clinics of North America 2011;44(1):133-60.
  • Kutluay A, Çankal D. Oral mukozanın premalign beyaz lezyonları. Ege Üniversitesi Dişhekimliği Fakültesi Dergisi 2009;30(2):75-86.
  • Oygür T. Ağız lezyonları ve temel patogenetik mekanizmalar. Ağız patolojisi ders kitabı. Ankara: Efil Yayınevi; 2010.
  • Tekin M, Çam O. Oral mukoza hastalıkları ve semptomatolojisi. Klinik Gelişim 2012;25:93-8.
  • Yücetaş Ş. Ağız ve çevre dokusu hastalıkları. First ed. Ankara: Atlas Kitapçılık; 2005:192-97.
  • Farah C, Lynch N, McCullough M. Oral fungal infections: an update for the general practitioner. Aust Dent J 2010;55:48-54.
  • Sharon V, Fazel N. Oral candidiasis and angular cheilitis. Dermatologic therapy 2010;23(3):230-42.
  • Addy M, Hunter ML. Can tooth brushing damage your health? Effects on oral and dental tissues. Int Dent J 2003;53(S3):177-86.
  • Bilge M, Akgül HM, Dağistan S. Diş hekimliğinde muayene ve oral diagnoz. First ed. Erzurum: Atatürk Üniveristesi Yayınları; 2012:143-7, 346-51.
  • Karakuzu A, Özçelik S. Oral mukozanın bakteriyel enfeksiyonları. Turkiye Klinikleri Journal of Dermatology Special Topics 2015;8(4):29-34.
  • Kelly AP, Taylor SCe. Dermatology for skin of color. Dermatology for skin of color. First ed. New York: McGraw-Hill; 2009.
  • Carnelio S, Rodrigues G, Shenoy R, Fernandes D. A brief review of common oral premalignant lesions with emphasis on their management and cancer prevention. Indian Journal of Surgery 2011;73(4):256-61.
  • Shafer WG, Hine MK, Levy BM, Rajendran R, Sivapathasundharam B. A textbook of oral pathology. Fourth ed. Saunders Philadelphia: Elsevier Health Sciences; 1983:786. Weidner N, Cote RJ, Suster S, Weiss LM. Modern surgical pathology. Second ed. Saunders: Elsevier Inc.; 2009.
  • Regezi JA, Scinbbaj J, Jordan RC. Oral pathology. Fifth ed. Philadelphia: Elsevier/Saunders; 2008.
  • Thoma KH, Gorlin RJ, Goldman HMe. Thoma's oral pathology. Sixth ed. London: Henry Kimpton: CV Mosby; 1970.
  • Walton K, Bowers E, Drolet B, Holland K. Childhood lichen planus: demographics of a US population. Pediatric dermatology 2010;27(1):34-8.
  • Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. British Journal of Oral and Maxillofacial Surgery 2008;46(1):15-21.
  • Alrashdan M, Cirillo N, McCullough M. Oral lichen planus: a literature review and update. Arch Dermatol Res 2016;308(8):539-51.
  • Silverman S, Gorsky M, Lozada-Nur F. A prospective follow-up study of 570 patients with oral lichen planus: persistence, remission and malignant association. Oral Surgery, Oral Medicine, Oral Pathology 1985;60(1):30-4.
  • Soto M, Rojas G, Esguep A. Association between psychological disorders and the presence of Oral lichen planus, Burning mouth syndrome and Recurrent aphthous stomatitis. Medicina oral: organo oficial de la Sociedad Espanola de Medicina Oral y de la Academia Iberoamericana de Patologia y Medicina Bucal 2004;9(1):1-7.
  • Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clinics in dermatology 2010;28(1):100-8.
  • Andreasen J. Oral lichen planus: I. A clinical evaluation of 115 cases. Oral Surgery, Oral Medicine, Oral Pathology 1968;25(1):31-42.
  • Sharma G, Sardana D, Vohra P, Rehani S, Nagpal A. Oral lichen planus in a pediatric patient: A novel therapeutic approach. Journal of dentistry (Tehran, Iran) 2017;14(2):109.
  • Jean J, Goldberg S, Khare R, et al. Retrospective analysis of candida-related conditions in ınfancy and early childhood caries. Pediatr Dent 2018;40(2):131-35.
  • Özcan İ. Sistemik yaklaşımlarla oral diagnoz. First ed. İstanbul: Nobel Tıp; 2006:565.
  • Laskaris G. Ağız hastalıklarının tedavileri Kürklü E (çeviren). İstanbul: Nobel Tıp Kitabevleri; 2007:71.
  • Van Heerden W. Oral manifestations of viral infections. South African Family Practice 2006;48(8):20-4.
  • Kumar A, Bagewadi A, Keluskar V, Singh M. Efficacy of lycopene in the management of oral submucous fibrosis. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodont 2007;103(2):207-13.
  • Chitguppi C, Brar T. Paediatric oral submucous fibrosis - The neglected pre-malignancy of childhood. Int J Pediatr Otorhinolaryngol 2017;97:55-60.
  • Siriwardena B, Jayawardena K, Senarath N, Tilakaratne W. An evaluation of clinical and histopathological aspects of patients with oral submucous fibrosis in the background of oral squamous cell carcinoma. BioMed research international 2018;2018:4154165.
  • Jornet P. White sponge nevus: presentation of a new family. Pediatric dermatology 2008;25(1):116-17.
  • Scully C, Porter S. Orofacial disease: update for the dental clinical team: 3. White lesions. Dental update 1999;26(3):123-9.
  • Bui T, Young J, Frausto R, Markello T, Glasgow B, Aldave A. Hereditary benign intraepithelial dyskeratosis: Report of a case and re-examination of the evidence for locus heterogeneity. Ophthalmic genetics 2016;37(1):76-80.
  • Kasapçopur Ö, Arısoy N. Ergenlik çağında bağ dokusu hastalıkları. Türk Pediatri Arşivi 2011;46(11):118-27.
  • Ayala Z, Martínez R, Mendieta S, Benadón E, Faugier E, Rocío Maldonado-Velázquez M. Acute myocardial infarction in a child with systemic lupus erythematosus and antiphospholipid syndrome. Archives of Rheumatology 2009;24(3):156-8.
  • Külahlı G, Erdoğmuş S, Sağlam ZA, Ergüven M. Adölesan dönemde tanı alan bir sistemik lupus eritematozus olgusu. J Kartal TR 2016;27(1):79-82.
  • O’brien M. Children’s Dental Health in the United Kingdom 1993 Report of Dental Survey Office of Population Censuses and Surveys. First ed. London: Her Majesty’s Stationery Office; 1994.
  • Ceyhan D, Akdik C. Okul öncesi çocuklarda oral mukozal premalign durumlar ve teşhis yöntemleri SDÜ Sağlık Bilimleri Enstitüsü Dergisi 2007;8(3):69-75.
  • Reamy B, Derby R, Bunt C. Common tongue conditions in primary care. Am Fam Physician 2010;81(5):627-34.
  • Crespo M, del Pozo P, García R. Epidemiología de la patología de la mucosa oral más frecuente en niños Epidemiology of the most common oral mucosal diseases in children. Medicina oral, patologia oral y cirugia bucal 2005;10:376-87.
  • Ellepola A, Samaranayake L. Inhalational and topical steroids, and oral candidosis: a mini review. Oral Dis 2001;7(4):211-6.
  • Kılıç M, Taşkın E, Selmanoğlu A. Primer immün yetmezlikli olgularımızın retrospektif değerlendirilmesi. Firat Tip Dergisi 2015;20(1):37-42.
  • Bessa C, Santos P, Aguiar M, Do Carmo M. Prevalence of oral mucosal alterations in children from 0 to 12 years old. Journal of Oral Pathology & Medicine 2004;33(1):17-22.
  • Samaranayake L, K. Cheung L, Samaranayake Y. Candidiasis and other fungal diseases of the mouth. Dermatologic Therapy 2002;15(3):251-69.
  • Dar-Odeh NS, Shehabi AA. Oral candidosis in patients with removable dentures. Mycoses 2003;46(5-6):187-91.
  • Neville B, Day T. Oral cancer and precancerous lesions. CA: a cancer journal for clinicians 2002;52(4):195-215.
  • Mallick S, Benson R, Rath G. Radiation induced oral mucositis: a review of current literature on prevention and management. European Archives of Oto-Rhino-Laryngology 2016;273(9):2285-93.
  • Scully C, Hegarty A. The oral cavity and lips Rook’s Textbook of Dermatology. Burns T, Breathnach S, Cox N, Griffiths C (Editor). Seventh ed. New Jersey: Blackwell Science; 2004:69.1-69.129.
  • Elston D, Meffert J. Photo quiz. What is your diagnosis? Fordyce spots. Cutis 2001;68(1):24, 49.
  • Abe M, Sogabe Y, Syuto T, Ishibuchi H, Yokoyama Y, Ishikawa O. Successful treatment with cyclosporin administration for persistent benign migratory glossitis. The Journal of dermatology 2007;34(5):340-3.
  • Drage L, Rogers R. Burning mouth syndrome. Dermatologic clinics 2003;21(1):135-45.
  • Pinheiro Rdos S, de Franca T, Ferreira Dde C, Ribeiro CM, Leao JC, Castro G. Human papillomavirus in the oral cavity of children. J Oral Pathol Med 2011;40(2):121-6.
  • Karen J, Schaffer J. Pachyonychia congenita associated with median rhomboid glossitis. Dermatology online journal 2007;13(1):21.

Oral Mukozal Beyaz Lezyonlar

Year 2019, , 670 - 683, 30.09.2019
https://doi.org/10.17098/amj.624695

Abstract

Diş hekimliği, kulak burun boğaz ve
dermatoloji polikliniklerinde sıklıkla karşılaşılan patolojiler arasında yer
alan oral mukozal lezyonlar; enfeksiyöz, otoimmün, premalign ya da malign
lezyonların habercisi olabilecekleri gibi sekonder olarak sistemik hastalığın
oral tutulumu şeklinde de ortaya çıkabilirler. Bu nedenle oral mukozal
lezyonların erken tanısı ve tedavisi önemlidir. Oral mukozanın beyaz lezyonları
klinikte fokal, çoklu veya yaygın odaklar halinde, sağlam mukozayla aynı
seviyede, yüzeyi düzgün olabildiği gibi dantel görünümünde, normal seviyeden
hafifçe kabarık, üzeri tüylü, katlanmış lezyonlar olarak karşımıza çıkabilir.
Bu lezyonlar ileride fissürlü, ülseratif, eroziv veya enflamatuar lezyonlar haline
dönüşebilirler.

Detaylı hasta muayenesi ve anamneziyle oral mukozal beyaz lezyonların çoğunda
tanıya kolaylıkla ulaşılabilmekte ve gerekli tedavi uygulanabilmektedir. Bu
nedenle ağız lezyonlarının bulguları, sistemik hastalıkların ağız bulguları,
lezyonların malignite potansiyeli değerlendirilerek hastalara yaklaşılmalıdır.
Klinik bulgular lezyonun kökeni ve tanısı konusunda önemli ipuçları
vermektedir. Ağız lezyonlarının erken teşhisi ve uygun yaklaşımları,
hastalıkların prognozunda ve hastaların yaşam kalitesinde olumlu sonuçlar
ortaya çıkaracaktır. Bu nedenle ağız lezyonlarının bulguları, sistemik
hastalıkların ağız bulguları, lezyonların malignite potansiyeli
değerlendirilerek hastalara yaklaşılmalıdır. Bu derlemenin amacı; oral mukozal
beyaz lezyonları detaylı inceleyerek ve hastalarda görülen mukozal lezyonların
güncel yaklaşımlarını değerlendirerek diş hekimleri ve pedodontistlerin
farkındalığını artırmaktır.

References

  • Said S, Golitz L. Vesiculobullous eruptions of the oral cavity. Otolaryngologic Clinics of North America 2011;44(1):133-60.
  • Kutluay A, Çankal D. Oral mukozanın premalign beyaz lezyonları. Ege Üniversitesi Dişhekimliği Fakültesi Dergisi 2009;30(2):75-86.
  • Oygür T. Ağız lezyonları ve temel patogenetik mekanizmalar. Ağız patolojisi ders kitabı. Ankara: Efil Yayınevi; 2010.
  • Tekin M, Çam O. Oral mukoza hastalıkları ve semptomatolojisi. Klinik Gelişim 2012;25:93-8.
  • Yücetaş Ş. Ağız ve çevre dokusu hastalıkları. First ed. Ankara: Atlas Kitapçılık; 2005:192-97.
  • Farah C, Lynch N, McCullough M. Oral fungal infections: an update for the general practitioner. Aust Dent J 2010;55:48-54.
  • Sharon V, Fazel N. Oral candidiasis and angular cheilitis. Dermatologic therapy 2010;23(3):230-42.
  • Addy M, Hunter ML. Can tooth brushing damage your health? Effects on oral and dental tissues. Int Dent J 2003;53(S3):177-86.
  • Bilge M, Akgül HM, Dağistan S. Diş hekimliğinde muayene ve oral diagnoz. First ed. Erzurum: Atatürk Üniveristesi Yayınları; 2012:143-7, 346-51.
  • Karakuzu A, Özçelik S. Oral mukozanın bakteriyel enfeksiyonları. Turkiye Klinikleri Journal of Dermatology Special Topics 2015;8(4):29-34.
  • Kelly AP, Taylor SCe. Dermatology for skin of color. Dermatology for skin of color. First ed. New York: McGraw-Hill; 2009.
  • Carnelio S, Rodrigues G, Shenoy R, Fernandes D. A brief review of common oral premalignant lesions with emphasis on their management and cancer prevention. Indian Journal of Surgery 2011;73(4):256-61.
  • Shafer WG, Hine MK, Levy BM, Rajendran R, Sivapathasundharam B. A textbook of oral pathology. Fourth ed. Saunders Philadelphia: Elsevier Health Sciences; 1983:786. Weidner N, Cote RJ, Suster S, Weiss LM. Modern surgical pathology. Second ed. Saunders: Elsevier Inc.; 2009.
  • Regezi JA, Scinbbaj J, Jordan RC. Oral pathology. Fifth ed. Philadelphia: Elsevier/Saunders; 2008.
  • Thoma KH, Gorlin RJ, Goldman HMe. Thoma's oral pathology. Sixth ed. London: Henry Kimpton: CV Mosby; 1970.
  • Walton K, Bowers E, Drolet B, Holland K. Childhood lichen planus: demographics of a US population. Pediatric dermatology 2010;27(1):34-8.
  • Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. British Journal of Oral and Maxillofacial Surgery 2008;46(1):15-21.
  • Alrashdan M, Cirillo N, McCullough M. Oral lichen planus: a literature review and update. Arch Dermatol Res 2016;308(8):539-51.
  • Silverman S, Gorsky M, Lozada-Nur F. A prospective follow-up study of 570 patients with oral lichen planus: persistence, remission and malignant association. Oral Surgery, Oral Medicine, Oral Pathology 1985;60(1):30-4.
  • Soto M, Rojas G, Esguep A. Association between psychological disorders and the presence of Oral lichen planus, Burning mouth syndrome and Recurrent aphthous stomatitis. Medicina oral: organo oficial de la Sociedad Espanola de Medicina Oral y de la Academia Iberoamericana de Patologia y Medicina Bucal 2004;9(1):1-7.
  • Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clinics in dermatology 2010;28(1):100-8.
  • Andreasen J. Oral lichen planus: I. A clinical evaluation of 115 cases. Oral Surgery, Oral Medicine, Oral Pathology 1968;25(1):31-42.
  • Sharma G, Sardana D, Vohra P, Rehani S, Nagpal A. Oral lichen planus in a pediatric patient: A novel therapeutic approach. Journal of dentistry (Tehran, Iran) 2017;14(2):109.
  • Jean J, Goldberg S, Khare R, et al. Retrospective analysis of candida-related conditions in ınfancy and early childhood caries. Pediatr Dent 2018;40(2):131-35.
  • Özcan İ. Sistemik yaklaşımlarla oral diagnoz. First ed. İstanbul: Nobel Tıp; 2006:565.
  • Laskaris G. Ağız hastalıklarının tedavileri Kürklü E (çeviren). İstanbul: Nobel Tıp Kitabevleri; 2007:71.
  • Van Heerden W. Oral manifestations of viral infections. South African Family Practice 2006;48(8):20-4.
  • Kumar A, Bagewadi A, Keluskar V, Singh M. Efficacy of lycopene in the management of oral submucous fibrosis. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodont 2007;103(2):207-13.
  • Chitguppi C, Brar T. Paediatric oral submucous fibrosis - The neglected pre-malignancy of childhood. Int J Pediatr Otorhinolaryngol 2017;97:55-60.
  • Siriwardena B, Jayawardena K, Senarath N, Tilakaratne W. An evaluation of clinical and histopathological aspects of patients with oral submucous fibrosis in the background of oral squamous cell carcinoma. BioMed research international 2018;2018:4154165.
  • Jornet P. White sponge nevus: presentation of a new family. Pediatric dermatology 2008;25(1):116-17.
  • Scully C, Porter S. Orofacial disease: update for the dental clinical team: 3. White lesions. Dental update 1999;26(3):123-9.
  • Bui T, Young J, Frausto R, Markello T, Glasgow B, Aldave A. Hereditary benign intraepithelial dyskeratosis: Report of a case and re-examination of the evidence for locus heterogeneity. Ophthalmic genetics 2016;37(1):76-80.
  • Kasapçopur Ö, Arısoy N. Ergenlik çağında bağ dokusu hastalıkları. Türk Pediatri Arşivi 2011;46(11):118-27.
  • Ayala Z, Martínez R, Mendieta S, Benadón E, Faugier E, Rocío Maldonado-Velázquez M. Acute myocardial infarction in a child with systemic lupus erythematosus and antiphospholipid syndrome. Archives of Rheumatology 2009;24(3):156-8.
  • Külahlı G, Erdoğmuş S, Sağlam ZA, Ergüven M. Adölesan dönemde tanı alan bir sistemik lupus eritematozus olgusu. J Kartal TR 2016;27(1):79-82.
  • O’brien M. Children’s Dental Health in the United Kingdom 1993 Report of Dental Survey Office of Population Censuses and Surveys. First ed. London: Her Majesty’s Stationery Office; 1994.
  • Ceyhan D, Akdik C. Okul öncesi çocuklarda oral mukozal premalign durumlar ve teşhis yöntemleri SDÜ Sağlık Bilimleri Enstitüsü Dergisi 2007;8(3):69-75.
  • Reamy B, Derby R, Bunt C. Common tongue conditions in primary care. Am Fam Physician 2010;81(5):627-34.
  • Crespo M, del Pozo P, García R. Epidemiología de la patología de la mucosa oral más frecuente en niños Epidemiology of the most common oral mucosal diseases in children. Medicina oral, patologia oral y cirugia bucal 2005;10:376-87.
  • Ellepola A, Samaranayake L. Inhalational and topical steroids, and oral candidosis: a mini review. Oral Dis 2001;7(4):211-6.
  • Kılıç M, Taşkın E, Selmanoğlu A. Primer immün yetmezlikli olgularımızın retrospektif değerlendirilmesi. Firat Tip Dergisi 2015;20(1):37-42.
  • Bessa C, Santos P, Aguiar M, Do Carmo M. Prevalence of oral mucosal alterations in children from 0 to 12 years old. Journal of Oral Pathology & Medicine 2004;33(1):17-22.
  • Samaranayake L, K. Cheung L, Samaranayake Y. Candidiasis and other fungal diseases of the mouth. Dermatologic Therapy 2002;15(3):251-69.
  • Dar-Odeh NS, Shehabi AA. Oral candidosis in patients with removable dentures. Mycoses 2003;46(5-6):187-91.
  • Neville B, Day T. Oral cancer and precancerous lesions. CA: a cancer journal for clinicians 2002;52(4):195-215.
  • Mallick S, Benson R, Rath G. Radiation induced oral mucositis: a review of current literature on prevention and management. European Archives of Oto-Rhino-Laryngology 2016;273(9):2285-93.
  • Scully C, Hegarty A. The oral cavity and lips Rook’s Textbook of Dermatology. Burns T, Breathnach S, Cox N, Griffiths C (Editor). Seventh ed. New Jersey: Blackwell Science; 2004:69.1-69.129.
  • Elston D, Meffert J. Photo quiz. What is your diagnosis? Fordyce spots. Cutis 2001;68(1):24, 49.
  • Abe M, Sogabe Y, Syuto T, Ishibuchi H, Yokoyama Y, Ishikawa O. Successful treatment with cyclosporin administration for persistent benign migratory glossitis. The Journal of dermatology 2007;34(5):340-3.
  • Drage L, Rogers R. Burning mouth syndrome. Dermatologic clinics 2003;21(1):135-45.
  • Pinheiro Rdos S, de Franca T, Ferreira Dde C, Ribeiro CM, Leao JC, Castro G. Human papillomavirus in the oral cavity of children. J Oral Pathol Med 2011;40(2):121-6.
  • Karen J, Schaffer J. Pachyonychia congenita associated with median rhomboid glossitis. Dermatology online journal 2007;13(1):21.
There are 53 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Reviews
Authors

Arife Kaptan

Elif Tekin This is me

Publication Date September 30, 2019
Published in Issue Year 2019

Cite

APA Kaptan, A., & Tekin, E. (2019). Oral Mukozal Beyaz Lezyonlar. Ankara Medical Journal, 19(3), 670-683. https://doi.org/10.17098/amj.624695
AMA Kaptan A, Tekin E. Oral Mukozal Beyaz Lezyonlar. Ankara Med J. September 2019;19(3):670-683. doi:10.17098/amj.624695
Chicago Kaptan, Arife, and Elif Tekin. “Oral Mukozal Beyaz Lezyonlar”. Ankara Medical Journal 19, no. 3 (September 2019): 670-83. https://doi.org/10.17098/amj.624695.
EndNote Kaptan A, Tekin E (September 1, 2019) Oral Mukozal Beyaz Lezyonlar. Ankara Medical Journal 19 3 670–683.
IEEE A. Kaptan and E. Tekin, “Oral Mukozal Beyaz Lezyonlar”, Ankara Med J, vol. 19, no. 3, pp. 670–683, 2019, doi: 10.17098/amj.624695.
ISNAD Kaptan, Arife - Tekin, Elif. “Oral Mukozal Beyaz Lezyonlar”. Ankara Medical Journal 19/3 (September 2019), 670-683. https://doi.org/10.17098/amj.624695.
JAMA Kaptan A, Tekin E. Oral Mukozal Beyaz Lezyonlar. Ankara Med J. 2019;19:670–683.
MLA Kaptan, Arife and Elif Tekin. “Oral Mukozal Beyaz Lezyonlar”. Ankara Medical Journal, vol. 19, no. 3, 2019, pp. 670-83, doi:10.17098/amj.624695.
Vancouver Kaptan A, Tekin E. Oral Mukozal Beyaz Lezyonlar. Ankara Med J. 2019;19(3):670-83.