30 Most Common Lesions Flashcards
What is a differential dx?
A list of all the possibilities arranged from the most common to the least common
What is the #1 most common lesion of the oral cavity?
Leukoplakia
What is is a leukoplakia?
A pre-malignant intraoral white plaque (1) that does not rub off (2) and can not be identified as any known entity (3)
Also, #1 most common
What are 5 other white lesions that can be scraped off?
- Materia Alba
- White Coated Tongue
- Burn (thermal, chemical, cotton roll)
- Pseudomembranous candidiasis
- Allergy (toothpaste or mouthwash)
What is the treatment for white coated tongue?
Treatment is tongue scraping or brushing
Best is a flat, stainless steel bar in a horse shoe shape
What are 6 other white plaques that do not rub off?
- Linea Alba
- Leukoedema
- Nicotine Stomatitis
- Oral Hairy Leukoplakia
- Tobacco Pouch Keratosis
- Lichen Planus
What is the treatment for linea albua?
No treatment necessary
In what population is leukoedema most common? What is the treatment?
In 70-90% of African people (bilateral)
No treatment necessary
What is the cause of nicotine stomatitis? What is another name for nicotine stomatitis? What is the treatment?
It is a callous from heat
Smoker’s keratosis
Stop smoking to see if the lesion disappears withing 2 weeks
What population is at risk for oral hairy leukoplakia? What virus is associated?
AIDS patients *remember this is bilateral!
Epstein Barr Virus
What is the treatment for Tobacco Pouch Keratosis?
Move the tobacco to see if the lesion disappears withing 2 weeks
What is a pathognomonic sign of lichen planus? What is the cause of lichen planus? What is the treatment?
Wickham Striae
Autoimmune –> CD4 T cells = saw tooth rete ridges and a band of leukocytes
tx with an anti-inflammatory or topical steroid
What are the different results possible for leukoplakia?
Hyperkeratosis
Mild/Moderate/Severe Dysplasia
Carcinoma in stiu (SQCC)
What does carcinoma in situ mean?
Cancerous cells that are getting ready to invade
What are the high risk sites for leukoplakia?
Floor of mouth, tongue, and lip
*if there is a leukoplakia in these areas do not wait to do a biopsy
What is the best guide for the potential progression to cancer of leukoplakias ?
Degree of dysplasia
Severe = 16% transformation Moderate = 3-15% (take it out) Mild = <5% (watch it, and biopsy again if it changes)
What was the mean transformation time of leukoplakias into cancer? What does this mean for patients?
About 4.3 years
This means that leukoplakias need good follow up! Even if they have been removed, they need to be continually evaluated for reappearance and change
What is the 2nd most common lesion of the oral cavity?
Tori (palatinus and mandibularis)
When should tori be removed?
If they cause the patient pain (usually from frequent trauma), if it bothers the patient, or if they need dentures
What are the common different types of inflammation or irritation in the oral cavity?
Traumatic Ulcer
Pericoronitis
Periodontal Abscess
ANUG
What is the name for persisting traumatic ulcers involving skeletal muscles?
Traumatic ulcerative granuloma with stromal eosinophilia
What is the treatment for traumatic ulcerative granulomas with stromal eosinophilia?
Excise the inflamed tissue or/and inject a steroid
A topical steroid will not penetrate enough since this is a deep ulcer!
What steroid is used and what dose of steroid is used for traumatic ulcerative granulomas with stromal eosinophilia?
Kenalog 10 or 40
Need 10 mg of steroid for every 1 cm of granuloma tissue
10 = 10 mg/ml --> 1ml/cm 40 = 40 mg/ml --> .25 ml/cm
What is the tissue called that overlies the occlusal table?
Operculum
What is the most common neoplasm of the oral cavity? And where do they commonly occur?
Fibroma (but it is not a true neoplasm)
Buccal mucosa > labial mucosa > tongue > gingiva
What is the treatment for a fibroma?
Excision and submit biopsy to pathologist
What term describes ectopic sebacious glands?
Fordyce’s Granules
How common are Fordyce’s granules? Where do they occur and what is the treatment?
Occur in 80% of the population (yellowish white papules)
Buccal mucosa>lips
No treatment necessary
What term describes a benign proliferation of blood vessels?
Hemangioma
In what population are hemangiomas most common? How can a hemangioma dx be confirmed? What is the treatment?
In 10-12% of children
Clinically blanches under pressure
Treatment is surgery, laser tx, embolization
Where do recurrent aphthous ulcers occur? What is a characteristic feature of recurrent aphthous ulcers?
On non-keratinized, movable mucosa
Yellow fibrin membrane
How common are recurrent aphthous ulcers? What is the treatment?
Occur in 20-25% of the the popluation
Treat with topical steroids
What are the differences between minor, major, and herpetiform recurrent aphthous ulcers?
Minor: 3-10 mm in size, 1-2 weeks healing time, 1-5 lesions with fewest recurrences
Major: 1-3 cm in size, 2-6 weeks healing, possible scarring, 1-10 lesions
Herpetiform: 1-3 mm in size, 7-10 days healing, up to 100 lesions with the most recurrences
What term describes a benign proliferation of squamous epithelium? What is a characteristic of these lesions? What is the cause of the these lesions?
Papilloma
Pedunculated with “finger like” projections
HPV 6, 11
What are the most common locations of papillomas and what is the treatment?
Tongue > soft palate
Treatment is surgical excision
What are the different variations of papillomas? What are they caused by?
Verruca Vulgaris - HPV 2, 4, 6, 40
Condyloma Acuminatum - HPV 6, 11 and 16, 18 high risk
Focal Epithelial Hyperplasia (heck’s disease) - HPV 13, 32
Sinonasal Papillomas
What is caused by an ill fitting denture? What is the treatment?
Epulis Fissuratum
Excise the extra tissue and reline the denture
What is the histopathologic dx for epulis fissuratum?
Focal inflammatory fibrous hyperplasia
What term describes superficial veins on the ventral tongue?
Lingual variosities
What term describes numerous grooves or fissures on the dorsal tongue? What is it often associated with?
Fissured tongue
Often associated with Geographic tongue
What should be done if the patient experiences mild burning or soreness with fissured tongue?
Brush the tongue!
What are the other names for geographic tongue?
Erythema areata migrans, benign migratory glossitis –> erythema migrans if it is not on the tongue
What term describes something that looks like geographic tongue but in the vestibule, and is in celiac patients?
Pyostomatitis vegetans
What term describes a pebbly mucosa of patients who wear their dentures all day? How is it treated? What if it is erythematous too?
Inflammatory papillary hyperplasia
Surgical excision and reline the denture
Red indicates a yeast infection, so use an antifungal on the mouth and the denture
Where do recurrent herpes simplex lesion occur?
Almost always on keratinized, bound mucosa (like the palate)
What terms describe the initial exposure of herpes virus and is based on age?
Young children = acute herpetic gingivostomatitis
18 and older = pharyngotonsillitis
What are the antiviral medications for HSV?
Best to start with prodromal stages
Acyclovir 5% ointment, apply 6x a day Acyclovir 200 mg capsule - take 3 stat, one 5x day Famciclovir tablets Penciclovir 1% cream Prophylaxis = lysine 500 mg tab 1x a day
What term describes a vesicle filled with clear fluid? What if it is filled blood?
Mucocele
Blood filled is probably due to autoimmune disease like mucous membrane pemphigoid
What is the most common location for a mucocele? What causes them? What is the treatment?
The lower lip
Trauma to salivary duct
Excise the feeding gland
Why is it important to ask the history of the present lesion?
16 most common is scar tissue
Because it might be scar tissue from trauma or surgery and does not require treatment
What term describes a yeast infection at the corners of the mouth? What is the treatment?
Angular cheilitis
Treat with an antifungal and increase the vertical dimension to prevent pooling of saliva and folding of skin
What term describes lymphoid hyperplasia on the posterior lateral tongue? What is the treatment?
Lingual tonsil
No treatment
What term describes an accumulation of blood withing the tissues secondary to trauma? What is the treatment?
Hematoma
No treatment
What might tobacco pouch keratosis progress to if tobacco use continues?
Verrucous carcinoma
What are the terms that describe chronic biting of the cheeks, lips, or tongue? What is the treatment?
Morsicatio buccarum
Morsicatio labiorum
Morsicatio linguarum
No treatment or bite guard
What must lichen planus be differentiated from?
Lichenoid drug reactions (lichenoid mucositis)
What are the two forms of lichen planus?
Reticular and Erosive
What is the treatment of lichen planus?
Biopsy is the standard of care and then treat erosive with an anti-inflammatory
What do cutaneous lichen planus lesions look like?
Purple, pruritic, polygonal papules
What term describes bony protuberances on the buccal of the mandible/maxilla? What is the treatment?
Buccal exostoses
Removal if repeated trauma, aesthetic concerns, or if the patient is in need of dentures
What term describes an implantation of amalgam into oral tissue? How is diagnosis confirmed?
Amalgam tattoo
Take a radiograph, and if amalgam is not visible on radiograph, then biopsy lesion to rule out melanoma
(hint: amalgam tattoos generally have a more blue tint, NOT brown)
What term describes an oral freckle?
Oral melanotic macule
What term describes a central papillary atrophy of the tongue due to a yeast infection? What is the treatment?
Median Rhomboid glossitis
Treat with antifungals and brushing of the tongue
What can occur with hairy tongue?
Gagging, bad taste, halitosis and esthetic concerns
What can cause a smooth red tongue? What symptoms accompany this?
Pernicious anemia, medications, vitamin deficiencies
Burning and pain
What term describes a slow growing, painless, skin cyst associated with inflammation of a hair follicle? What is the treatment?
Epidermoid cyst
Surgical removal
Where do oral cysts occur?
Midline of the FOM
What term describes a benign tumor of fat? Where do they usually occur in the mouth? What is the treatment?
Lipoma
Buccal mucosa, tongue, FOM, lips
Surgical excision
