Lumps Inside the Lips: Common Causes (Fordyce Spots, Canker Sores, Herpes, Mucocele)

Intraoral lumps are common. Most are benign; persistent or symptomatic lesions need evaluation.

Common Causes

• Fordyce spots: Ectopic sebaceous glands. Yellow-white, 1–3 mm, bilateral buccal/labial mucosa. Asymptomatic. No treatment needed.
• Canker sores (aphthous ulcers): Round, yellow-white floor, red halo. Painful. Heal 7–14 days. Triggers: stress, trauma, SLS toothpaste.
• Herpes labialis (HSV-1): Vesicles → ulcers on vermillion border/perioral. Prodrome (tingling). Recurrent. Antivirals if frequent.
• Mucocele: Mucus extravasation cyst from traumatized minor salivary gland. Lower lip > upper. Fluctuant, bluish. May resolve or require excision.
• Fibroma: Reactive hyperplasia from chronic biting. Firm, pink, pedunculated/sessile.
• Pyogenic granuloma: Vascular, bleeds easily; pregnancy, trauma, medications.

Red Flags

• Ulcer >2 weeks without healing.
• Induration, fixation, bleeding, rapid growth.
• Unexplained weight loss, cervical lymphadenopathy.
• Immunosuppression.

When to Biopsy

Any lesion not resolving in 2 weeks, or with suspicious features. Oral SCC most common on lateral tongue, floor of mouth, but can affect lip mucosa.

Dentist or oral surgeon is the appropriate first provider.