Demographics and histopathological characteristics of palatal lesions: a 24-year retrospective study in an Iranian population

The palate is a site with a complex anatomy that can develop a variety of lesions of epithelial, salivary gland, and mesenchymal origins. Despite its clinical importance, it has rarely been studied as an independent site. The purpose of this study was to investigate the demographic and pathological features of palatal lesions over 24-years in an Iranian population. A retrospective study was performed on 283 palatal biopsies recorded between 2001 and 2024 at the Department of Oral and Maxillofacial Pathology, Shahid Beheshti Dental School, Tehran, Iran. Lesions were classified into eight histopathological categories. Demographic variables, clinical characteristics, and histological diagnoses were analyzed in RStudio (2024.12.1) using parametric and non-parametric tests with post-hoc adjustment, and significance was set at p < 0.05. Among 8,803 total biopsies, 283 cases (3.2%) involved the palate. Epithelial lesions were the largest group (30%), followed by salivary gland lesions (28.3%) and mesenchymal lesions (26.2%). Pleomorphic adenoma was the most common single diagnosis (14.8%). Malignant lesions accounted for 26.5% of the sample, with squamous cell carcinoma being the predominant malignancy. Malignant epithelial lesions occurred at a significantly older age and presented with larger clinical size compared with benign lesions, whereas benign and malignant salivary gland lesions showed overlapping clinical features. Most lesions were located in the posterior palate, a region that is frequently overlooked during routine clinical examination. The palate can be affected by a wide spectrum of lesions with a substantial proportion of malignancies. Older patient age and increased lesion size represent important clinical warnings, particularly for epithelial lesions. Given the limited clinical distinction between benign and malignant salivary gland lesions, biopsy of palatal lesions is strongly recommended regardless of appearance. These findings emphasize the importance of palatal examination and early histopathologic assessment to improve diagnostic accuracy and prognosis.