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AU15 - Oral Pathology Exam 1 > 09/02 - Malignant Epithelial Lesions > Flashcards

09/02 - Malignant Epithelial Lesions Flashcards

1
Q

What is the most common skin cancer?

A

basal cell carcinoma

*nearly 3 million cases diagnosed annually in the USA

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2
Q

Who is most at risk for basal cell carcinoma?

A

patients over 40 years old, who have a fair complexion, and a history of chronic sun exposure

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3
Q

Where do the majority of basal cell carcinoma develop?

A
  • 80% arise on the head and neck

- most develop in the middle 1/3 of the face (from eyebrows to above the lips)

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4
Q

What are the 3 types of basal cell carcinoma?

A
  • nodulo-ulcerative basal cell carcinoma
  • pigmented basal cell carcinoma
  • sclerosing (morpheaform) basal cell carcinoma
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5
Q

What is the most common clinical presentation of basal cell carcinoma?

A

nodulo-ulcerative basal cell carcinoma

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6
Q

Describe a nodulo-ulcerative basal cell carcinoma.

A
  • small nodule with a raised border
  • frequently has a history of bleeding
  • umbilicated pearly papule that may show central ulceration
  • lack of adnexal skin structures (hair)
  • may have fine blood vessels
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7
Q

Describe the histopathology of nodulo-ulcerative basal cell carcinoma.

A
  • basaloid cells that appear to “drop off” of the basal cell layer of the epidermis
  • large lobules of tumor cells are characteristic (think “nodulo”)
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8
Q

What do pigmented basal cell carcinoma resemble?

A

melanocytic nevi due to the presence of benign melanocytic colonization

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9
Q

Describe a pigmented basal cell carcinoma.

A
  • relatively short history (weeks/months) duration
  • lack of hair
  • pigmented
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10
Q

Describe the histopathology of pigmented basal cell carcinoma.

A
  • most have nodulo-ulcerative pattern with large lobules of tumor cells invading superficial connective tissue
  • lesion is pigmented because of activation of benign melanocytes
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11
Q

What is the least common basal cell carcinoma? What is the most aggressive basal cell carcinoma?

A

sclerosing (morpheaform) is the least common, but most aggressive form

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12
Q

Describe a sclerosing (morpheaform) basal cell carcinoma.

A
  • clinically resembles a scar due to induction of collagen formation by tumor cells
  • may be a firmness to lesion because fibrotic change
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13
Q

Describe the histopathology of sclerosing basal cell carcinoma.

A
  • tiny infiltrative nests of tumor cells in a collagenous background
  • very difficult to assess borders clinically because of this infiltrative growth pattern
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14
Q

What is the treatment for basal cell carcinoma?

A
  • scalpel excision
  • electrocautery and curettage
  • cryotherapy
  • topical agents (5-FU, imiquimod)
  • Mohs micrographic surgery
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15
Q

Describe the steps of Mohs micrographic surgery.

A
  • lesion is outlined on a patient’s face
  • curettage is performed
  • incisions are made along the outline and reference points are cut to align it
  • sliced tissue is removed
  • diagram is drawn on paper using the reference points
  • additional tissue is taken as needed and area is cauterized and sutured
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16
Q

What is the general prognosis for basal cell carcinoma?

A
  • generally excellent with over 95% of patients cured after first treatment
  • patients at increased risk for 2nd lesions
  • rare metastatic spread has been reported
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17
Q

What features warrant Mohs surgery?

A

basal cell carcinoma that has:

  • larger lesions
  • recurrent lesions
  • tumor in areas of embryonic fusion
18
Q

What is the most common oral malignancy and the second most common cutaneous malignancy?

A

squamous cell carcinoma

19
Q

What areas are most affected by squamous cell carcinoma?

A

skin and lower vermilion zone of the lip

20
Q

What does cutaneous squamous cell carcinoma often arise from? Where?

A
  • arises from pre-existing actinic keratosis, due to chronic sun exposure (UV light)
  • face, helix of ear, dorsum of hand, arms
21
Q

What is the treatment for cutaneous squamous cell carcinoma? Prognosis?

A
  • TX: surgical excision
  • PROGNOSIS: usually actinically-induced squamous cell carcinomas are well-differentiated and slow-growing so generally good prognosis if diagnosed early
22
Q

What are the risk factors for oral squamous cell carcinoma?

A
  • 75-80% are associated with cigarette smoking (further increased with combined cigarette and alcohol)
  • 20-25% have no identifiable risk factor
23
Q

If there is no identifiable risk factor, where is oral squamous cell carcinoma likely to develop?

A
  • lateral tongue of younger people

- gingiva of older women

24
Q

In what age group and gender is oral squamous cell carcinoma most often found?

A
  • most in adults over age 45
  • men outnumber women 2.5:1
  • accounts for 3-4% of all cancers in USA
25
Q

Describe an oral squamous cell carcinoma lesion.

A
  • irregular shape, mixture of red and white clinically
  • often ulcerated
  • exophytic or endophytic growth pattern
  • often much firmer than surrounding tissues
  • early lesions are asymptomatic; pain is later feature
  • ragged radiolucency is characteristic of lesions that involve the underlying bone
26
Q

When does squamous cell carcinoma of the lip often develop? What type of growth? Prognosis?

A
  • commonly involved site secondary to chronic sun exposure (actinic cheilitis)
  • slow-growing well-differentiated lesions
  • relatively good prognosis, but if they are not producing a lot of keratin, they are of a higher grade and more progressive lesion
27
Q

Where does squamous cell carcinoma of the tongue often develop? What are the highest risk factors?

A
  • lateral tongue
  • majority of patients have history of cigarette and alcohol abuse, but when it is seen in younger people, it almost always develops at this site
28
Q

What are the 2 most common sites for oral squamous cell carcinoma?

A
  • lateral tongue

- floor of the mouth

29
Q

Who is most commonly afflicted with squamous cell carcinoma of the gingiva and alveolar mucosa?

A
  • more common in women (2:1)
  • more common in patients with no identifiable risk factors
  • unusual site epidemiologically for oral squamous cell carcinoma

*there is no link between use of smokeless tobacco and oral cancer

30
Q

True or false: The buccal mucosa is a common site for oral squamous cell carcinoma.

A

FALSE

31
Q

Where do most squamous cell carcinomas of the palate arise? Where could it have originated?

A
  • mostly on lateral soft palate
  • relatively uncommon presentation
  • may be difficult to determin whether lesion originated in oral cavity or developed in maxillary antrum and perforated sinus floor
32
Q

What are some of the clinical differential diagnoses of sqamous cell carcinoma?

A
  • non-specific ulcer
  • specific infection (tuberculosis, syphilis, deep fungal)
  • immune-mediated conditions (Wegener’s granulomatosis, Crohn’s disease)
33
Q

Describe squamous cell carcinoma radiographically.

A
  • due to direct invasion of the bone (usually a late phenomenon)
  • ragged “moth-eaten” radiolucency
  • ill-defined borders
  • pathologic fracture possible
34
Q

Describe the histopathology of squamous cell carcinoma.

A
  • microscopically, invasive cords and nests of malignant squamous epithelial cells arise from dysplastic surface epithelium
  • tumor cells show increased nuclear/cytoplasmic ratio, cellular and nuclear pleomorphism, and mitotic activity
  • varying degrees of keratin production may be seen (well vs. poorly differentiated)
35
Q

What is the treatment for squamous cell carcinoma?

A
  • wide surgical excision and/or radiation therapy
  • combined radiochemotherapy used with extensive loco-regional involvement or in cases where surgery is contraindicated
  • surgery is the basis

*periodic follow-up examination after treatment is complete is absolutely necessary

36
Q

What is the prognosis for squamous cell carcinoma?

A
  • generally poor because most patients present in Stage III or IV
  • metastasis to regional lymph nodes
  • at 60% 5-year survival, one of the worst prognoses of any major cancer
  • (after treatment is complete?) 10-20% of these patients will develop new upper aerodigestive tract malignancies, particularly if carcinogenic habits are continued
37
Q

What is verrucous carcinoma?

A

less aggressive, relatively uncommon, form of squamous cell carcinoma

38
Q

Who is most often affected by verrucous carcinoma?

A
  • usually develops in elderly males
  • smokeless tobacco is often mentioned as contributing factor (most of our cases have not shown association with smokeless tobacco)
39
Q

What is the clinical presentation of verrucous carcinoma? Most frequent sites?

A
  • diffuse white or mixed red/white plaque; tends to grow laterally
  • alveolar mucosa, hard palate, and buccal mucosa are most frequent sites
40
Q

Describe the histopathology of verrucous carcinoma.

A
  • microscopically appears very bland
  • often misdiagnosed
  • broad pushing border, not infiltrating at the base
41
Q

How is verrucous carcinoma diagnosed?

A

based on the overall architecture of the tumor, rather than the appearance of individual cells

42
Q

What is the treatment for verrucous carcinoma?

A
  • surgical excision is generally recommended
  • radiation therapy have been generally discouraged due to sporadic reports of transformation into more aggressive squamous cell carcinoma!
  • approximately 20-25% of verrucous carcinoma, upon completion of excision, show foci of tranformation to routine squamous cell carcinoma

AU15 - Oral Pathology Exam 1 (4 decks)

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