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Clinical Summary

Extravascular (hemorrhagic) oral lesions are purplish/red discoloration of the oral tissue due to the extravasation of blood. The lesions can be divided based on size into petechiae (1- to 2-mm pinpoint red areas), purpura (< 1 cm), and ecchymosis (> 1 cm). The lesions are usually the result of trauma but may also be a manifestation of platelet disorders (thrombocytopenia), leukemia, vascular disorders (vasculitis), and coagulation disorders (scurvy, disseminated intravascular coagulation). The most common sites are the ones most susceptible to trauma, such as the tongue, buccal mucosa, and palate.

Management and Disposition

When the lesion is caused by trauma, the blood will slowly reabsorb over a period of a few days and no treatment will be necessary. Larger lesions might take weeks to resolve.

If there is no history or signs of trauma, further workup is needed. A complete blood count and peripheral blood smear along with coagulation studies may help rule out underlying systemic disease.


  1. Hemorrhagic oral lesions are negative to diascopy. Diascopy involves the application of pressure with a glass slide onto the surface of the lesion and examining the lesions through the glass for blanching; hemorrhagic oral lesions do not blanch.

  2. In many cases, buccal ecchymosis is the first sign of thrombocytopenia.


Buccal Ecchymosis. This patient had extensive buccal ecchymosis secondary to benign trauma from chewing. The patient had a platelet count of less than 5000 secondary to idiopathic thrombocytopenic purpura. Note also the small petechiae on the soft palate. (Photo contributor: R. Jason Thurman, MD.)

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