08/26 - Premalignant Epithelial Lesions

Question 1

Describe a leukoplakia lesion.

Answer 1

white patch of the oral mucosa that cannot be scraped off and cannot be diagnosed clinically as any other condition; sharply demarcated with variable surface (smooth, wrinkled, micronodular)

Question 2

True or false: A biopsy is mandatory to diagnose leukoplakia.

Answer 2

true; biopsy is done if it is persistent or progressive; may turn out just to be hyperkeratosis

Question 3

Is leukoplakia considered premalignant?

Answer 3

yes

Question 4

What other conditions can be differential diagnoses for leukoplakia?

Answer 4

• leukoedema
• cheek/tongue chewing
• frictional keratosis
• nicotine stomatitis
• smokeless tobacco keratosis
• aspirin burn
• candidiasis
• lichen planus (typically generalized)
• white sponge nevus (congenital)
• cinnamon reaction

Question 5

What type of condition does this describe?

• occurs in pipe smoker or people who smoke 3-4 packs/day
• small salivary glands are responding to chemicals in the palate
• not well-defined
• would normalize in 3-4 weeks if the smoker stops

Answer 5

nicotine stomatitis

Question 6

What type of condition does this describe?

• mucosa is acting as an occlusal surface and a callus is forming
• no well-defined crisp margin

Answer 6

frictional keratosis

Question 7

What type of condition does this describe?

• patchy, pulled out appearance (“shag carpet”)
• margin is not defined

Answer 7

cheek chewing

Question 8

What type of condition does this describe?

• bilateral
• disappears when stretched
• “quilted appearance”

Answer 8

leukoedema

Question 9

What type of condition does this describe?

• will normalize in 2 weeks or less if the patient stops the habit
• not associated with an increase in oral cancer unless the patient also smokes

Answer 9

smokeless tobacco keratosis

Question 10

What type of condition does this describe?

• bilateral
• if you stretch it, it doesn’t disappear
• talk to parents/sibs to see if anyone else is affected
• excessive epithelium is being produced

Answer 10

white sponge nevus

Question 11

What type of condition does this describe?

• coagulative necrosis (outline of the cells are there but the nucleus is gone)
• dead sheet of epithelium

Answer 11

aspirin burn

Question 12

Leukoplakia is most common in what age range and gender? In people with what habits?

Answer 12

• older adult males (>40 years old)

- tobacco use (cigarettes), UV exposure

Question 13

What are the most common sites for leukoplakia? Which sites are highest risk for dysplasia or carcinoma?

Answer 13

• 70% in the lip vermilion, buccal mucosa, or gingiva

- highest risk: tongue, floor of mouth, lip vermilion

Question 14

Which leukoplakia lesions are higher risk of being premalignant: homogenous in color or heterogenous?

Answer 14

heterogenous

Question 15

Describe the histology of leukoplakia.

Answer 15

• hyperkeratosis (appears white)

- abrupt transition from normal epithelium

Question 16

What are the odds of leukoplakia having a precancerous or dysplastic change?

Answer 16

5-25%, average 10%

Question 17

What treatment is recommended for leukoplakia?

Answer 17

• any mild dysplasia - discontinue carcinogenic habits and watch
• moderate dysplasia or worse - remove by the most convenient means available

Question 18

What is the prognosis of leukoplakia?

Answer 18

• guarded prognosis
• 15% of non-dysplastic lesions will transform if not treated
• 33% of dysplastic lesions will transform
• 30% of leukoplakia recur

Question 19

Describe an erythroplakia lesion.

Answer 19

a red patch that cannot be diagnosed as any other condition clinically; velvety red, well-demarcated patch, usually affecting the lateral tongue, floor of the mouth, or soft palate

Question 20

Where is an erythroplakia lesion usually found?

Answer 20

lateral tongue, floor of the mouth, or soft palate

Question 21

In erythroplakia, ___% of the lesions are severe epithelial dysplasia or worse at the time of biopsy

Answer 21

90%

Question 22

The red appearance of erythroplakia is usually due to what? Is this more likely to be a higher or lower grade lesion than leukoplakia?

Answer 22

• lack of keratin production

- higher grade (red lesion = red flag)

Question 23

What is the treatment for erythroplakia?

Answer 23

most likely, remove the lesion by the most convenient means available

Question 24

Describe an actinic (solar) keratosis.

Answer 24

premalignant sun-induced skin lesion caused by chronic UV exposure; scaly plaque with reddish base and a sandpaper texture

Question 25

In what patients and where do actinic keratosis occur?

Answer 25

• fair-skinned persons over age 40

- on the facial skin and vermilion zone of the lower lip

Question 26

Describe the histology of actinic keratosis.

Answer 26

• hyper keratosis (white) and epithelial atrophy (red)

- may have some degree of epithelial dysplasia or carcinoma-in-situ

Question 27

What can actinic keratosis give rise to?

Answer 27

invasive squamous cell carcinoma

Question 28

How is actinic keratosis treated?

Answer 28

• topical liquid nitrogen
• surgical excision
• laser ablation
• 5-fluorouracil (5-FU, Effludex)
• imiquimod (Aldara)

*patient must be monitored for development of new lesions

Question 29

What is the prognosis for actinic keratosis?

Answer 29

fair to good

Question 30

What is actinic cheilosis (cheilitis)?

Answer 30

term for actinic keratosis involving the vermilion zone of th elower lip

Question 31

Describe an actinic cheilosis lesion.

Answer 31

chronic scaling, ulceration, atrophy, and/or fissuring of the lip; can be blurring of the vermilion border

Question 32

What is the treatment for actinic cheilosis?

Answer 32

• vermilionectomy with advancement of the labial mucosa
• laser ablation of the involved vermilion zone
• 5-FU and imiquimod (in select cases)

*patients should use sunblock or avoid the sun for long-term follow-up