White Sponge Naevus — ORE Part 1 MCQ

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ModerateOral PathologyWhite Sponge NaevusORE Part 1

A patient presents with a white spongy thickening of the buccal mucosa bilaterally that has been present since childhood. Family members are similarly affected. The tissue peels but reforms. What is the most likely diagnosis?

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Correct answer: C — White sponge naevus

White sponge naevus (WSN) is the only diagnosis consistent with all stem features. It is an autosomal dominant inherited disorder presenting bilaterally symmetrical, thickened white plaques of buccal mucosa, typically from childhood, and runs in families. The reversibility ('peels but reforms') reflects the benign, non-scarring nature of the condition and the tendency of scales to shed and regrow over days. Lichen planus is inflammatory with reticular/erosive patterns, not spongy diffuse thickening, and is not hereditary. Leukoplakia is diagnostically defined as non-removable and carries malignant transformation risk (WSN does not). Chronic cheek biting is traumatic and unilateral or irregular. Leukoedema is a benign opalescent variant that disappears on stretching and is most common in dark-skinned populations, not a familial inherited disorder.

Reference: Martels H Jr, Pereira SM, Rocha TM, et al. White sponge nevus: report of a three-generation family. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(1):43–47. https://pubmed.ncbi.nlm.nih.gov/17178493/; and Rugg EL, McLean WHI, Allison WE, et al. A mutation in the mucosal keratin K4 is associated with oral white sponge nevus. Nat Genet. 1995;11(4):450–452.