Necrotizing sialometaplasia: a sheep in wolf's clothing. Healing as a diagnostic test

Necrotizing sialometaplasia is a benign self-limited intraoral lesion that is easily confused both clinically and histologically with squamous cell carcinoma. It presents as a painless ulceration, frequently on the hard palate, that histologically shows necrosis, inflammation, squamous metaplasia, and granulation tissue. It is thought to be due to infarction of minor salivary glands and heals spontaneously in six to 12 weeks. A brief period of observation for evidence of healing can be an important diagnostic clue in distinguishing this entity from cancer, thus saving the patient unnecessary surgery or radiation therapy.