Howdy All,
TLDR is just the next line...
I was wondering if anyone has had their foliate papillae removed in a biopsy?
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Background larger narrative:
My situation is that I've noted that my foliate papillae on the right side of my tongue have tended to be more red and slightly enlarged, really throughout the 4 years between the dysplastic luekoplakia was biopsied and when my 2nd biopsy found Oral Squamous Cell Carcinoma (OSCC).
If I recall what my 2nd oral surgeon said on my first and second visit with him several years ago, is that they can do that through allergies and immune responses. That the redness and slight prominence I was seeing was exactly what he'd expect to see on a healthy tongue. He mentioned that if they were bothering me there was an antihistamine allergy medication was found to be effective in treating them in they were bothersome. They didn't hurt, and I only brought it up as a concern to be sure there was nothing cancer generating or relating going on there. They did seem to ebb and flow over the many months. Never sore, just sometimes when I'd look at my tongue to keep an eye on things they'd appear more red and prominent, and then other times they'd be less red and match the left side of the tongue.
I believe my ENT oncology surgeon that I am seeing now for regular follow up following the very partial glossectomy for the OSCC agreed with what this other oral surgeon (an oncology specializing one) had said regarding irritation, allergy, immune response, and normal cycle of things.
The foliate papillae were about a centimeter from the OSCC pimple like lesion, but not removed during the partial glossectomy. The scar of the expanded margin excision is now about 3-5 mm below the foliate papillae. No further cancer was found during the partial glossectomy, just more dysplasia, and dysplasia extending to the margins of the excision, if I recall correctly.
Since the excision scar has healed over with a typical white scar (as I understand it from the ENT surgeon), a few splotches of white lesions have arisen above and below the excision scar. They are painless and have no feelable (palpable?) difference in texture to the surrounding tongue tissue, although one has a very slight thickened feeling, but nothing I'd be able to detect if I wasn't really looking for it.
There is a new (since partial glossectomy) white patch, about like a fingernail clipping, long and thing that kind of extends from the scar to the foliate papillae, which seem to now have been in a perpetual red, slightly more prominent state since the partial glossectomy.
I've been mentioning this to the ENT Oncology surgeon during every checkup every few months. He is willing to biopsy anything I am worried about, but he does not feel it is indicated at this point from his opinion on how it looks and feels.
He explained that the surgery was not a gentle process on the tongue, scar tissue formation, suture healing and wound closure and all that pulls the tongue into a new shape. Some of the occasional fleeting cramping minor pain sensation I get is likely just that, scar tissue, tongue getting pulled in new ways. Same is true for the foliate papillae staying red, that region was obviously abused during the surgery process, tissue trauma is a necessary aspect of carving chunks of flesh out, and the body responds. I get that, and it makes sense.
I am very happy with my tongue as it is now, and I don't know if that area of the foliate papillae is like a danger zone for surgery (I'll try to remember what ENT surgeon says this time) with a higher risk of messing up taste functions, or difficult healing due to the molar teeth edges rubbing more on that part of the tongue than the part that was removed before further down.
But it has been a year and four months now.
I am not sure if its expected for the foliate papillae to be perpetually red and what that white line extending from the scar is about.
Initially some of it I thought was from where the sutures were. I think the one bump and tiny white pimple spot was one that I have pictures of being a spot where a suture was. I need to remember to ask the doctor about that, is it normal for a suture hole site to scar over and leave a prominence this long after surgery. It's not getting bigger at this point or changing any more, so not overly concerned about it, but we are keeping a close eye on all the lesions. (I see him here in a couple weeks again and am organizing my thoughts a bit stream of conscious blogging...sorry).
There is another white lesion, probably pencil eraser (the one on the end of a pencil) sized, below the scar and towards the back of it. That one on some days I can just barely feel it. The surgeon cannot with his gloved finger, and explained, interestingly to me anyway, that the way our brains work, often we can feel things on ourselves that even a skilled surgeon cannot. So he wasn't discounting that I could feel something, just it wasn't prominent enough for him to detect it. Again he's happy to biopsy anything that is concerning to me, just he is of the opinion it isn't anything he'd insist be done, falling into the gray area of reasonable to be done, but nothing setting of alarms in his professional opinion.
Finally just forward of the partial glossectomy scar on the tongue there is an area of tissue that is just more sensitive. It has never been biopsied. It does the whole capillary bleaching thing, that the oral surgeon who did the cancer finding biopsy explained to me on previous visits that the white area I was noticing really only "popped" when I stretched my tongue out to it's limits (by just sticking my tongue out, not yanking on it with my hand or anything, but I've done a lot of tongue sticking out excercise over the years so I can see the area and take pictures). That area, originally just a faint white, did become much more obvious with the tongue stretched out to its maximum, so I agree with the oral surgeons observation there.
He said when I relaxed my tongue it mostly disappeared, which was different than all my other leukoplakia lesions.
His explanation makes total sense, except for the question why just that one region of tongue tissue experienced capillary bleaching, that was something that was never explained to my satisfaction, but it was not a smoking gun for another biopsy.
I think it was about a year later the pimple lesion erupted from an area between that white capillary bleaching area, which was adjacent to the scar from my initial biopsy 3-4 years prior, and the biopsy scar which found the previous moderate epithelial dysplasia. The pimple like lesion eruption from the spot just posterior to that blanching area was biopsied and came back OSCC.
So now the area of the tongue forward of the partial glossectomy scar, has intermittent and varying intensity, similar white patchy coloration, not like the other permanenlty white spots and splotches I have/had, and seems like the skin there is super sensitive to touch, and feels kind of like a blister that has 90% healed, where it doesn't quite hurt, but it is super sensitive to friction and is uncomfortable if you rub it, where as any other part of my tongue I can rub vigoursly with no discomfort whatsoever.
I've also discussed this area of concern regularly with the doctor.
Trying to be vigilantly and at the same time not brutalize the tongue needlessly; potentially irritating “sleeping” dysplastic tissue.
I guess I’ll post this war and peace blog like update as is.
Any thoughts on those who may have been in similar situations are appreciated.
Thank you,
Chris
Last edited by ChrisCQ; 06-08-2025 07:57 PM.
