The Clinical Value of Diascopy

Diascopy is a simple yet often overlooked technique that can potentially aid in identifying vascular lesions of the oral cavity. The technique involves using a clear material (i.e. glass slide, glass carpule of local anesthetic, or rigid strip of plastic) to depress the lesion in order to observe blood dissipating intravascularly, giving the tissue a “blanched” appearance.¹

A 58-year-old female presented to the oral medicine service for evaluation of multiple lip lesions that had been present for an unknown duration. She stated that the lesions were asymptomatic, but the lesion on the vermillion border of the upper lip spontaneously hemorrhaged and hemostasis was prolonged. Her past medical history was significant for alcohol induced liver cirrhosis. Physical examination revealed multiple violaceous lesions on the vermillion borders of the upper and lower lips with a prominent lesion on the right upper lip (Fig. 1, arrows). Diascopy was performed on this lesion, with gentle pressure resulting in minor resolution of the lesion (Fig. 2) and with increased pressure resulting in complete resolution of the lesion (Fig. 3). The clinical diagnosis was consistent with lip lesions of vascular etiology secondary to alcohol-induced liver cirrhosis. The patient was referred to the oral and maxillofacial surgery service for possible cauterization of the hemorrhagic lesion on the upper lip.

Oral structures may demonstrate hemorrhagic changes and petechiae secondary to liver cirrhosis and it is important for oral health care providers to recognize the widespread manifestations of this condition.² Diascopy is a valuable clinical technique to potentially identify vascular lesions of the oral cavity regardless of etiology.