If a lesion cannot be diagnosed based on history and clinical findings alone, an oral tissue biopsy may be necessary. When additional information is required to guide any indicated therapy, biopsy to provide tissue for microscopic analysis is often the definitive procedure. Oral tissue biopsies might be performed on the lip, tongue, palate, or gingiva.
Oral biopsies are recommended for lesions that last for two weeks or longer after potential irritants are removed. Malignant lesions are suspected if the lesion:
- is red or red and white
- is ulcerated, indurated, or fixed to deeper tissues
- grows rapidly
- bleeds easily
Biopsies can be performed with a brush swab; scalpel biopsies may be warranted. It is often difficult to distinguish benign and early malignant lesions, so the decision to forego biopsy should be made with great care.