Mucoscopic features of oral potentially malignant disorders and oral squamous cell carcinoma: A systematic review

Abstract

Objective

Early detection of oral potentially malignant disorders (OPMDs) and their progression to oral squamous cell carcinoma (OSCC) remains challenging due to subtle clinical presentation. Mucoscopy, a non-invasive extension of dermoscopy for oral mucosa, allows real-time visualization of vascular and surface patterns, but its diagnostic features are not well established.

Methods

This systematic review aimed to synthesize mucoscopic features of healthy oral mucosa, OPMDs, and OSCC. The review followed PRISMA guidelines and was registered in PROSPERO (CRD420251007205). PubMed, Scopus, and ScienceDirect were searched up to January 2026. Eligible studies reported mucoscopic or dermoscopic findings in human OPMDs or OSCC. Studies of healthy oral mucosa were included as a reference for comparison. Data on vascular morphology, surface architecture, and color patterns were qualitatively analyzed.

Results

Healthy mucosa showed organized hairpin, dot, and glomerular vessels on a pale-rosy background. OPMDs exhibited disrupted vascular patterns and epithelial irregularities, with lesion-specific features such as white structureless areas in leukoplakia, scaling and pigmentation in actinic cheilitis, and Wickham striae in oral lichen planus. OSCC demonstrated polymorphous vascularity, ulceration, keratinization, and extensive structureless areas.

Conclusion

Mucoscopy identifies consistent vascular and structural patterns that may aid differentiation between benign, premalignant, and malignant oral lesions. Standardized criteria are needed to improve diagnostic accuracy and support early detection.

1. Introduction

Oral diseases with neoplastic potential, particularly oral potentially malignant disorders (OPMDs), remain a significant public health concern requiring urgent and effective management.¹ According to the Global Burden of Disease (GBD) 2021 data from the Institute for Health Metrics and Evaluation (IHME), the incidence of lip and oral cavity cancer continues to rise globally,² and around 52% of the global mortality from oral cancers comes from Southeast Asia This highlights the urgency to develop intervention strategies, especially in developing countries with scarce health care services.³ While awareness is increasing, this upward trend highlights the critical need for early detection and improved diagnostic strategies for successful intervention.

One of the major challenges in managing OPMDs and oral cancers, especially OSCC, lies in their early identification. OPMDs represent a heterogeneous group of lesions with an established risk of malignant transformation, most commonly progressing to oral squamous cell carcinoma. These lesions often present as asymptomatic and are clinically subtle in their initial stages, earning them the term “silent killers”.⁴ As a result, they frequently go unnoticed by patients and may also be missed during routine dental examinations. Although regular biannual oral screening is encouraged, general practitioners may face difficulties recognizing early malignant transformations due to overlapping features with benign lesions and the subtle nature of early mucosal changes.⁵

Many patients with OPMDs and OSCC are diagnosed at later stages due to the lack of early detection tools. To address this, the involvement of oral medicine specialists becomes essential, not only in clinical diagnosis but also in guiding the development and implementation of diagnostic adjuncts. In recent years, several non-invasive imaging tools have emerged to support the early detection of suspicious mucosal lesions.⁶ In this context, adjunctive diagnostic tools such as mucoscopy, an adaptation of dermoscopy for mucosal surfaces, have gained interest. Dermoscopy has demonstrated diagnostic value in dermatology and vulvar lesions, suggesting its potential application to oral mucosal tissue as a non-invasive, real-time imaging modality.^7,8 When used on oral mucosa lesion, mucoscopy enables magnified visualization of vascular and surface patterns, potentially enhancing diagnostic accuracy compared to conventional visual examination. This highlights the possible superiority of mucoscopy over naked-eye inspection.⁹

Despite increasing interest in mucoscopy for oral mucosal assessment, the available evidence is scattered across small observational studies and case reports, and no standardized framework currently exists for interpreting mucoscopic findings in OPMDs and OSCC. A systematic synthesis is therefore needed to identify recurring vascular and surface patterns, clarify differences between healthy, potentially malignant, and malignant oral mucosa, and define gaps that should be addressed in future diagnostic studies.

This systematic review aims to qualitatively synthesize and compare reported mucoscopic features of healthy oral mucosa, OPMD, and OSCC, with the objective of identifying lesion-specific vascular, surface, and colour patterns relevant to early recognition. By summarizing characteristic mucoscopic patterns, this review seeks to clarify the role of mucoscopy as an adjunctive imaging tool in oral oncology and to provide a descriptive foundation for future research, including the development of artificial intelligence–assisted diagnostic applications, particularly in resource-limited settings.

2. Methods

The protocol of this study has been registered in International Prospective Register for Systematic Review (PROSPERO) with registration number CRD420251007205 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

2.1. Review question

This systematic review aims to qualitatively synthesize and compare reported mucoscopic features of healthy oral mucosa, OPMD, and OSCC, with the objective of identifying lesion-specific vascular, surface, and colour patterns relevant to early recognition. The review question is “What mucoscopic vascular, surface, and color features have been reported in OPMDs and OSCC, and how do these features differ from healthy oral mucosa?”

2.2. Inclusion and exclusion criteria

Inclusion criteria comprised observational or interventional studies reporting mucoscopic or dermoscopic findings in human oral potentially malignant disorders (OPMDs) or oral squamous cell carcinoma (OSCC). Studies evaluating healthy oral mucosa were also included to provide reference mucoscopic patterns for comparison.

The PICOS framework (Population, Intervention, Comparison, Outcomes, and Study design) was used to select the studies:

(P) Human participants with OPMDs, including but not limited to oral leukoplakia, proliferative verrucous leukoplakia, oral erythroplakia, oral lichen planus, oral submucous fibrosis, actinic cheilitis, and other recognized OPMDs, or patients with OSCC involving the oral cavity or vermilion lip. Healthy oral mucosa was included as a reference group.

Oral lichen planus was distinguished from oral lichenoid lesions according to the diagnosis reported in the original studies. Only lesions explicitly diagnosed as OLP were categorized as OLP in the present review; oral lichenoid lesions were not pooled with OLP.

(I) Evaluation of oral mucosal lesions using mucoscopy or dermoscopy, regardless of device type, magnification, or contact method.

(C) Healthy oral mucosa.

(O) Mucoscopic features, including vascular morphology, surface architecture, and color or pigmentary patterns of the oral mucosa.

(S) Observational studies (cross-sectional, case–control, cohort studies) and interventional studies reporting mucoscopic findings, without restriction on publication year and published in English.

Exclusion criteria were as follows: (1) studies assessing dermoscopic features of non-oral mucosal sites or cutaneous lesions without oral involvement; (2) studies lacking specific mucoscopic or dermoscopic descriptions of oral mucosal features; (3) studies focused exclusively on device development, image-processing algorithms, or artificial intelligence without reporting primary mucoscopic findings; and 4) studies focusing exclusively on oral conditions outside the predefined scope of OPMDs and OSCC, including benign, inflammatory, infectious, vascular, pigmented, and non-OSCC malignant lesions, except studies of healthy oral mucosa included as a reference comparator.

2.3. Information source and search strategy

A comprehensive literature search was conducted in January 2026 using the following databases: PubMed (US National Library of Medicine, USA), Scopus, and ScienceDirect, without any date limitations. To identify potentially missing studies, a supplementary search was conducted using the reference lists of the included studies.

The search strategy used a search term to each database: [(“mucoscopy” OR “mucoscopic” OR “dermoscopy” OR “dermoscopic”) AND (“oral mucosa” OR “oral cavity” OR “oral lesion” OR “mouth” OR “tongue” OR “lip” OR “buccal mucosa”) AND (“oral potentially malignant disorder” OR “OPMD” OR “oral leukoplakia” OR “leukoplakia” OR “proliferative verrucous leukoplakia” OR “PVL” OR “oral erythroplakia” OR “erythroplakia” OR “oral lichen planus” OR “OLP” OR “oral submucous fibrosis” OR “oral submucosal fibrosis” OR “OSMF” OR “actinic cheilitis” OR “chronic hyperplastic candidiasis” OR “oral squamous cell carcinoma” OR “OSCC” OR “oral cancer")]. Terms related to healthy or normal oral mucosa were also searched to identify studies providing reference mucoscopic features.

The syntax was adapted according to the requirements of each database. Reference lists of the included studies were also manually screened to identify potentially eligible studies not retrieved through the electronic search.

2.4. Study selection

Once the search was completed, all citations were uploaded using the online software Rayyan (Qatar Computing Research Institute, Doha, Qatar), EndNote 20 (EndNote, Clarivate Analytics, Philadelphia, PA, USA) and Microsoft Excel to eliminate duplicates and select eligible articles.

The titles and abstracts of all reports in the electronic searches were individually read by two investigators (MDCS, KAN, WLK and SRMRS), excluding articles that did not meet the eligibility criteria. The two reviewers proceeded with reading the full text of the articles screened to identify the eligible articles, and all the primary reasons for exclusions were registered for the composition of article selection flow.

Studies reporting mucoscopy of oral conditions other than OPMDs or OSCC were excluded during full-text assessment because they did not address the predefined review question.

2.5. Data extraction and analysis

All studies meeting the inclusion criteria were extracted and organized according to reported outcomes, including vascular patterns, surface morphology, pigmentation, and structural changes. Findings were qualitatively synthesized and compared with features described in healthy oral mucosa.

Formal diagnostic-accuracy measures were rarely reported. Although some studies provided histopathological confirmation or correlations between mucoscopic and histological findings, the available data were insufficient and too heterogeneous to calculate pooled sensitivity or specificity or to perform a diagnostic-accuracy meta-analysis.

3. Result

3.1. Study characteristics

A total of 17 studies were included describing mucoscopic or dermoscopic findings of healthy oral mucosa, OPMDs, and OSCC (Fig. 1). Four studies, comprising 265 participants, described mucoscopic features of healthy oral mucosa, while one study including 82 participants, described on smoking-associated oral mucosal changes.

Fig. 1.

PRISMA flow chart for selecting the study.

Among OPMDs, nine studies were included. Seven studies reported mucoscopic findings in a total of 36 participants, while two studies did not report the number of participants. Oral lichen planus was the most frequently reported OPMD, described in six studies, followed by actinic cheilitis in two studies and oral leukoplakia in one study. Although the eligibility criteria encompassed OPMDs broadly, eligible mucoscopic studies were identified only for oral leukoplakia, actinic cheilitis, and oral lichen planus. No eligible studies reporting mucoscopic features of other OPMDs, such as oral submucous fibrosis, proliferative verrucous leukoplakia, or oral erythroplakia, were identified.

Four studies reported mucoscopic features of OSCC in a total of 63 participants.

3.2. Mucoscopic features of healthy and smoking-associated oral mucosa

Mucoscopic evaluation of the oral mucosa demonstrated a range of characteristic vascular and surface patterns in both healthy oral mucosa and smoking-associated oral mucosal changes. In clinically normal mucosa, submucosal capillaries were clearly visible and commonly arranged as grouped, chain-shaped, or matchstick-shaped hairpin vessels, as well as dot and glomerular vessels. Occasional microaneurysms and hemorrhagic dots were also reported (Table 1).

Table 1.

The mucoscopy features of normal mucosa.

Ref	Cases (n)	Color of mucosa	Vascular/capillary pattern	Surface and structural features	Diagnosis	Location
10	1	NR	Submucosal capillaries clearly visible	NR	Healthy oral mucosa	Labial mucosa
11	30	Pale rosy to rosy	Hairpin pattern; subepithelial punctation	Thin biotype with focal epithelial disjunction	Healthy oral mucosa	Lip, cheek, floor of mouth, ventral and lateral tongue, alveolar ridge, soft palate
12	152	NR	Grouped, chain-shaped, and matchstick hairpin vessels; dot vessels; glomerular vessels; hemorrhagic dots; microaneurysms	Hyperkeratosis; honeycomb appearance; microulceration; white dots; yellowish-white streaks; yellow background; targetoid brown areas	Healthy oral mucosa	Labial mucosa
13	82	NR	Grouped, chain-shaped, and matchstick hairpin vessels; dot and glomerular vessels; hemorrhagic dots; microaneurysms	Hyperkeratosis; honeycomb appearance; microulceration; white dots; yellowish-white streaks; yellow background; purple or brown areas	Healthy oral mucosa	Labial mucosa
13	82	NR	Hemorrhagic dots; matchstick hairpin vessels; microaneurysms	Hyperkeratosis; white dots	Smoking-associated oral mucosal changes	Labial mucosa

*NR = not reported.

Surface features of healthy oral mucosa included a honeycomb pattern, hyperkeratosis, microulceration, white dots, yellowish-white streaks, yellow background areas, and, in some cases, targetoid brown round areas. When colour was reported, the mucosa typically appeared pale rosy to rosy. In individuals with a thin mucosal biotype, subepithelial punctation and small foci of epithelial disjunction were noted. These findings were described across multiple anatomical sites, including the labial mucosa, buccal mucosa, floor of the mouth, ventral and lateral tongue, alveolar ridge, and soft palate.

In smoking-associated oral mucosal changes, mucoscopic findings included hemorrhagic dots, matchstick-shaped hairpin vessels, and microaneurysms, frequently accompanied by hyperkeratosis and white dots (Table 1).

Overall, mucoscopy enabled detailed visualization of submucosal capillary patterns and epithelial surface characteristics, revealing variations in oral mucosal appearance across different anatomical sites. Representative mucoscopic features of healthy oral mucosa are illustrated in Fig. 2.

Fig. 2.

Illustration of mucoscopic features of normal mucosa.

3.3. Mucoscopic features of OPMDs

Mucoscopic features of oral potentially malignant disorders exhibited vascular and surface patterns distinct from those observed in healthy oral mucosa. While healthy mucosa was commonly characterized by organized hairpin and dot vessels on a homogeneous rosy background with a regular honeycomb surface pattern, OPMDs demonstrated irregular vascular distribution, altered surface architecture, and heterogeneous pigmentation. Representative mucoscopic features of oral potentially malignant disorders are shown in Fig. 3.

Fig. 3.

Illustration of mucoscopic features of OPMD.

3.3.1. Leukoplakia

Leukoplakia was characterized by white plaques composed of irregular, structureless whitish-pink or reddish areas and thick linear clods. Typical vascular patterns observed in healthy oral mucosa, such as hairpin and dot vessels, were frequently absent. Red structureless areas were also reported in some lesions (Table 2).

Table 2.

The dermoscopy of OPMD.

Ref	Cases (n)	Clinical characteristics	Color of lesion	Vascular/capillary pattern	Surface or structural features	Diagnosis	Location
14	1	White plaque	NR	Absent typical vascular pattern	Irregular white structureless areas; whitish-pink and reddish clods; thick lines; red structureless zones	Leukoplakia	Lateral tongue
15	1	Scales and erosion	NR	NR	White structureless areas; scales; white halos at vermilion border	Actinic cheilitis	Lip
15	1	Pigmentation of lip	NR	NR	Non-homogeneous structure; brown or black globules; parallel lines; light-brown structureless areas	Actinic cheilitis	Lower lip
16	1	Violaceous-to-dark-grey discoloration with blunted papillae; bright red erosions; interspersed white reticular lesions	NR	Curvilinear vessels	Veil-like grey-white areas; speckled pearly surface; bright red depressions; violaceous-to-brown clods; dotted pattern	Oral lichen planus	Dorsum of tongue
17	30	Diffuse lesions with unclear borders	Rosy	Hairpin capillaries (buccal); punctuation capillaries (oral mucosa)	Hyperkeratosis; furrows; cracks; light-to-intense red erosions; reduced transparency; disturbed architecture	Oral lichen planus	Buccal mucosa
18	NR	NR	NR	NR	Wickham striae	Oral lichen planus	Buccal mucosa
19	1	Raised whitish scaly plaque	NR	NR	Violaceous background; Wickham striae (linear and circular); diffuse scaling	Oral lichen planus	Lower lip
20	1	Whitish reticulated elevated plaque	NR	NR	Reticular white striae	Oral lichen planus	Lower lip
21	NR	Clinically resembled lichen planus	Violaceous	Dotted and linear vessels	NR	Oral lichen planus	Buccal mucosa

*NR = not reported.

3.3.2. Actinic cheilitis

Actinic cheilitis was characterized by scaling, erosion, and pigmentation of the vermilion lip. Mucoscopic features included white structureless areas, parallel lines, brown or black globules, and structureless light-brown zones. Compared with healthy oral mucosa, actinic cheilitis demonstrated a non-homogeneous surface architecture and reduced vascular regularity (Table 2).

3.3.3. Oral lichen planus

Among studies in which the lesions were diagnosed and reported as OLP, mucoscopic findings included violaceous, dark-grey, or whitish plaques, frequently accompanied by Wickham striae presenting as reticulated or linear white striae. Mucoscopic features included veil-like grey-white areas, a speckled pearly surface, bright-red erosions, violaceous-to-brown clods, and scattered dotted or curvilinear vessels. Additional surface findings included hyperkeratosis, furrows, cracks, and reduced epithelial transparency. Compared with healthy oral mucosa, OLP lacked a uniform rosy background and organized hairpin vasculature, instead displaying dotted and linear vessels within heterogeneous surface patterns (Table 2).

3.4. Mucoscopic features of OPMD vs Healthy mucosa

Mucoscopic evaluation revealed clear differences between healthy oral mucosa and OPMD. Healthy mucosa was commonly characterized by a well-organized vascular network composed of hairpin and dot vessels, glomerular loops, and occasional microaneurysms, set against a pale rosy to rosy background with a regular honeycomb surface pattern.

In contrast, OPMDs, including leukoplakia, actinic cheilitis, and OLP, exhibited less organized vascular patterns, altered epithelial surface architecture, and heterogeneous coloration. Leukoplakia and actinic cheilitis were frequently associated with white structureless areas, thick clods, and pigmentation changes that partially obscured the underlying vascular pattern. OLP demonstrated a violaceous or greyish background, Wickham striae, curvilinear or dotted vessels, and reduced epithelial transparency.

Across OPMDs, additional mucoscopic findings included hyperkeratosis, erosions, irregular lesion borders, and loss of vascular uniformity when compared with healthy oral mucosa (Table 3).

Table 3.

Mucoscopic features of each type of OPMD compared to healthy oral mucosa.

Mucoscopic features	Healthy mucosa	Leukoplakia	Actinic cheilitis	Oral lichen planus (OLP)
Color	Pale rosy to rosy	White plaque with irregular structureless areas	Scales, erosion, and brown or black pigmentation	Violaceous, dark grey, or whitish plaque
Vascular pattern	Hairpin vessels, dot vessels, glomerular vessels, microaneurysms	Vascular pattern obscured; thick reddish lines	Parallel lines; non-homogeneous vascular structures	Dotted, curvilinear, or punctuation capillaries
White structures	White dots; yellowish-white streaks	Whitish-pink clods; white structureless zones	White structureless areas; white halos	Wickham striae (reticulated or linear)
Hyperkeratosis	Mild or absent	Prominent	Present, producing a scaly surface	Marked, with furrows and cracks
Ulceration/erosion	Rare or absent	Usually absent	Common; erosions of varying intensity	Bright-red depressed areas and erosions
Tissue transparency	Normal	Reduced due to epithelial thickening	Reduced by scaling	Reduced with disturbed architecture
Background appearance	Regular honeycomb pattern; yellowish background	Red structureless and thick white areas	Light-brown structureless background	Veil-like grey-white or bluish-white areas; speckled pearly surface
Lesion borders	Well-defined	Irregular, poorly demarcated	Diffuse scaling; unclear borders	Diffuse, irregular; hyperkeratotic or furrowed surface
Common location	Labial mucosa, lips, tongue, buccal mucosa	Lateral tongue	Lips (particularly lower lip)	Buccal mucosa, tongue dorsum, lower lip

3.5. Mucoscopic features of OSCC

Mucoscopic examination of OSCC demonstrated pronounced vascular and surface irregularities when compared with healthy oral mucosa and oral potentially malignant disorders. Clinically, OSCC was described as indurated plaques, nodules, or ulcerative lesions with yellowish-pink, reddish, or mixed red-and-white coloration. Representative mucoscopic features of OSCC are presented in Fig. 4.

Fig. 4.

Illustration of mucoscopic features OSCC.

A frequent mucoscopic finding was polymorphous vascularity, including dotted, glomerular, arborizing, coiled, and linear-irregular vessels. Perivascular halos were reported in several studies. Surface features included white structureless areas, keratin plugs, blood spots, and focal ulcerations. Lesions ranged from well-differentiated crusted plaques with whitish-yellow surfaces to poorly differentiated lesions characterized by intensely vascular red areas and dense linear vessels. Compared with healthy oral mucosa, OSCC exhibited increased vascular density, irregular vessel orientation, and heterogeneous surface patterns (Table 4).

Table 4.

The dermoscopy of OSCC.

Ref	Cases (n)	Clinical characteristics	Color of lesion	Vascular/capillary pattern	Surface and structural features	Diagnosis	Location
22	1	Well-defined, indurated, lobulated plaque	Yellowish-pink	Polymorphous vessels (dotted, glomerular, arborizing, linear irregular, comma)	Central whitish-yellow keratin; white structureless zones; small ulcerations; blood spots	OSCC	Tongue dorsum
23	1	Painful nodular ulcerative lesion	Mixed red and white	White circles centered around keratin-filled cavities; polymorphous linear coiled vessels; perivascular halo	White structureless areas; blood spots	Well-differentiated OSCC	Tongue dorsum
24	1	Well-defined indurated plaque	Pink	Radially arranged, dotted, hairpin, arborizing, and coiled vessels; small blood spots	Central whitish-yellow keratin; yellowish-white background; white structureless areas; surface scales; perivascular halos	Well-differentiated OSCC	Lip
25	24	Elevated, mildly exophytic, ulcerated, crusted lesion	Whitish-yellow	Polymorphous pattern; dotted vessels (low density)	Whitish-yellow crust; ulceration; white dots; structureless areas; white halos	Well-differentiated OSCC	Lower lip
25	14	Nodular lesion	Pink	Dotted vessels (moderate density)	Hemorrhagic spots; brown-to-grey dots/globules	Moderately differentiated OSCC	Lower lip
25	22	Exophytic lesion	Red	Linear-irregular and polymorphous vessels (dense vascularity)	Brown-to-grey dots/globules	Poorly differentiated OSCC	Lower lip

3.6. Mucoscopic features of OSCC vs healthy mucosa

Mucoscopic comparison between healthy oral mucosa and OSCC revealed marked differences in vascular organization, surface architecture, and pigmentation. Healthy mucosa was characterized by a smooth surface, uniform pale-rosy coloration, and well-organized capillary networks forming hairpin, dot, and glomerular patterns within a regular honeycomb background.

In contrast, OSCC exhibited architectural distortion, irregular keratinization, and prominent vascular irregularity. OSCC commonly presented as indurated or ulcerated yellowish-pink to red lesions with polymorphous vascular patterns, including dotted, glomerular, arborizing, coiled, and linear-irregular vessels. Additional findings included white structureless areas, keratin plugs, blood spots, ulcerations, and perivascular halos, features not observed in healthy oral mucosa.

Overall, malignant oral lesions demonstrated substantial disruption of vascular organization and epithelial surface integrity when compared with healthy oral mucosa.

4. Discussion

This systematic review provides a qualitative synthesis of mucoscopic features across healthy oral mucosa, OPMD, and OSCC, highlighting how mucoscopy may contribute to improved pattern recognition in oral oncology. Rather than serving as a standalone diagnostic modality, mucoscopy appears best positioned as an adjunctive tool that enhances conventional clinical examination by revealing vascular and epithelial changes not readily visible to the naked eye.^9,26

A key contribution of this review lies in establishing baseline mucoscopic characteristics of healthy oral mucosa. The identification of consistent vascular organization, surface regularity, and uniform coloration provides an essential reference framework for interpreting pathological alterations ^{10, 11, 12,27}. Importantly, normal mucoscopic appearances varied according to anatomical site, reinforcing that accurate interpretation requires contextual awareness.^11,28 This finding aligns with broader dermoscopic principles, where site-specific morphology influences pattern recognition and diagnostic thresholds.

Beyond physiological variation, mucoscopy demonstrated sensitivity to subclinical epithelial and microvascular changes associated with environmental exposure, particularly tobacco use. The detection of early keratinization and vascular remodeling in smoking-associated mucosa suggests that mucoscopy may capture intermediate tissue responses before overt disease develops¹³ (Fig. 2). This raises the possibility of using mucoscopy for longitudinal monitoring in high-risk populations, although prospective validation is required.

Across OPMDs, the synthesis revealed shared patterns of epithelial thickening and vascular disruption, while also identifying lesion-specific configurations²⁹ (Fig. 3). These observations support the concept that diagnostic interpretation should rely on an integrated assessment of background colour, surface architecture, and vascular arrangement rather than isolated features. Such a multicomponent approach mirrors established diagnostic strategies in cutaneous dermoscopy and may help address the clinical challenge of overlapping appearances among OPMDs.

In malignant lesions, mucoscopic findings diverged according to tumor lineage. Keratinizing epithelial malignancies displayed prominent vascular polymorphism and surface disruption, whereas melanocytic malignancies were dominated by pigmentary heterogeneity with comparatively preserved surface architecture ^{14, 15, 16, 17, 18, 19,30,15,31, 32, 33}. Recognition of these divergent pattern profiles may aid earlier clinical suspicion and appropriate referral, while underscoring the continued necessity of histopathological confirmation.

Importantly, the implications of mucoscopy extend beyond lesion recognition alone. Evidence from cutaneous oncology suggests that enhanced visualization of vascular abnormalities and lesion borders may assist in biopsy site selection and margin assessment. Although data specific to oral oncology remain limited, these findings point toward a potential future role for mucoscopy in procedural guidance, meriting focused investigation.

The available evidence does not yet establish the diagnostic accuracy of mucoscopy. Most studies focused on descriptive mucoscopic patterns rather than diagnostic performance against histopathology. Prospective diagnostic-accuracy studies using histopathology as the reference standard are therefore needed.

Despite these promising insights, the current evidence base remains constrained. Included studies were limited in number, heterogeneous in design, and lacked standardized terminology, imaging protocols, and reporting frameworks. These limitations preclude quantitative synthesis and formal diagnostic accuracy assessment. In contrast to cutaneous dermoscopy, where consensus criteria are well established. Oral mucoscopy remains an evolving field requiring methodological harmonization.^6,7

Future research should prioritize standardized mucoscopic terminology, reproducibility assessment, histopathological correlation, and prospective diagnostic-accuracy studies. The development of standardized mucoscopic image datasets may also facilitate digital image analysis and artificial intelligence-assisted interpretation, potentially supporting wider clinical application, particularly in settings with limited access to specialist care.

From a clinical perspective, mucoscopy may serve as a non-invasive adjunct to conventional oral examination by improving visualization of vascular and surface changes, assisting lesion documentation and follow-up, and potentially helping clinicians identify areas that warrant biopsy. However, its routine clinical use requires standardized diagnostic criteria, assessment of interobserver reproducibility, and prospective validation against histopathological diagnosis. Future studies should also evaluate its integration with digital imaging and artificial intelligence-assisted interpretation.

5. Conclusion

This systematic review demonstrates that mucoscopy reveals consistent and distinguishable pattern differences in reported mucoscopic pattern among healthy oral mucosa, OPMD and OSCC. When interpreted in relation to baseline mucosal appearances, mucoscopic assessment enables recognition of progressive alterations in vascular organization, surface architecture, and pigmentation along the spectrum from normal tissue to malignancy.

While mucoscopy should not replace histopathological diagnosis, the synthesized evidence supports its role as a non-invasive adjunctive tool that may enhance clinical evaluation and lesion characterization when used alongside conventional examination. The ability to visualize microvascular and epithelial surface features not readily apparent to the naked eye highlights its potential utility in clinical assessment and follow-up of oral mucosal lesions.

This review is limited by the heterogeneity of included studies, small sample sizes, variable reporting standards, and the absence of standardized mucoscopic criteria. Additionally, most studies lacked direct correlation with histopathological outcomes, precluding assessment of diagnostic accuracy. Future research should focus on standardized terminology, anatomical site–specific reference patterns, and prospective studies integrating clinical, mucoscopic, and histopathological data. With appropriate validation and standardization, mucoscopy may become a valuable component of non-invasive oral mucosal evaluation in both clinical and resource-limited settings.

Patient consent statement

Patient consent was not required, as no identifiable human subjects were involved in this study.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics approval statement

Ethical approval was not required for this study, as it is a systematic review of previously published data.

Permission to reproduce material from other sources

No materials from other sources were reproduced in this study.

Human and animal rights statement

This article is a review and does not involve any original studies with human participants or animals performed by any of the authors. Therefore, ethical approval, informed consent, and animal use approval were not required.

Declaration of generative AI and AI-assisted technologies

During the preparation of this work the authors used ChatGPT to assist with grammar checking and language editing. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article.

Funding statement

This research received no external funding.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.