The tongue will exhibit a well-demarcated area of erythema, primarily affecting the dorsum, and often extending to involve the lateral borders of the tongue. Within the area of erythema, the normal tongue architecture will be effaced with loss of the filiform papillae and atrophy of the overlying mucosa. Similar lesions may be present concurrently on other aspects of the tongue or other mucosal sites. A polygenic mode of inheritance also has been suggested. No increased incidence has been noted with medication use or environmental agents.
Geographic tongue is described as a psoriasiform mucositis.
At the periphery, elongation of the rete ridges is noted with associated hyperparakeratosis and acanthosis. The predominant inflammatory infiltrate in the lamina propria is neutrophils with an admixture of chronic inflammatory cells. No medical intervention is required as the lesion is benign and most often asymptomatic. Biopsy is not usually necessary given the characteristic clinical presentation. Consultation with an oral pathologist is indicated if a question exists about the diagnosis.