Oral lesions mimicking hairy leukoplakia: a diagnostic dilemma

Oral hairy leukoplakia is seen in immunosuppressed persons infected with the human immunodeficiency virus and is a predictor of the development of acquired immunodeficiency syndrome in that population. Over the past 3 years we have seen 16 examples of a lesion that histologically resembles hairy leukoplakia but is found in patients who are not in risk groups for acquired immunodeficiency syndrome. All these specimens tested negative for Epstein-Barr virus DNA and for human papillomavirus antigen. Sera from five of the 16 patients were tested for antibodies to human immunodeficiency virus, and all results were negative. These findings suggest that the diagnosis of hairy leukoplakia cannot be based on histologic criteria alone but should be verified by DNA in situ hybridization for Epstein-Barr virus.