Fordyce granules appear as rice-like, white or yellow-white, asymptomatic papules of 1-3 mm. in greatest dimension. There is no surrounding mucosal change and the granules remain constant throughout life. The most common sites of occurrence are the buccal mucosa (often bilateral), the upper lip vermilion, and the mandibular retromolar pad and tonsillar areas, but any oral surface may be involved. Some patients will have hundreds of granules while most have only one or two.
Occasionally, several adjacent glands will coalesce into a larger cauliflower-like cluster similar to sebaceous hyperplasia of the skin. In such an instance, it may be difficult to determine whether or not to diagnose the lesion as sebaceous hyperplasia or sebaceous adenoma. The distinction may be moot because both entities have the same treatment, although the adenoma has a greater growth potential. It should be mentioned that sebaceous carcinoma of the oral cavity has been reported, presumably arising from Fordyce granules or hyperplastic foci of sebaceous glands.
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