ch. 10 Flashcards
What type of HPV causes Squamous papilloma most often?
6
11
What is a squamous papilloma?
stratified squamous epithelium proliferates (bump), benign
What does squamous papilloma look like?
Cauliflower (white, stalk)
Pedunculated (head is wider than the base)
What’s the differential diagnosis for squamous papilloma?
Verruca Vulgaris
Condyoloma acuminata
Verruciform Xanthoma
What is verruca vulgaris? What color? Is it contagious?
common wart
white (cause of hyper keratin)
contagious
What is the differential diagnosis for verruca vulgaris?
same as squamous papilloma
What is a condyloma acuminatum? how is it transmitted?
HPV wart (6,11) sexual contact
What’s the difference in papilloma vs condyloma?
Papilloma: smaller, lots of projections
Condyloma: bigger, more cobblestone looking, not many projections
What risk do anogenital Condyloma acuminatum have?
possible the hpv16,18 can become squamous cell carcinoma
What is HECK’s disease?
multifocal epithelial hyperplasia
What causes Heck’s disease (multifocal epithelial hyperplasia)?
HPV 13, 32
If condyloma acuminatum appears in a child what should you suspect?
Sexual abuse
What’s a sinonasal papilloma?
a goober lesion in the nose
What causes molluscum contagiosum?
DNA Poxvirus
What’s the other name for molluscum bodies?
Henderson paterson bodies
What do molluscum cont. look like? remission?
smooth, skin colored papules, 9 month remission
What’s another thing verruciform xanthoma looks like?
squamous papilloma
What is seborrheic keratosis?
extra oral benign proliferation of epidermal basal cells (looks like big brown moles)
What is Dermatosis papulosa nigra?
a form of seborrheic keratosis in Africans (Morgan Freeman)
What is Leser-Trelat sign?
a type of Seborrheic keratosis, 100’s of them show up because of underlying malignancy in the body
What is a freckle called?
Ephelis
What does UV light do to ephelis?
darkens the lesion
What does UV light do to Actinic lentigo?
Doesn’t darken it.
What causes Actinic lentigo?
Chronic UV exposure, brown macule
Where is actinic lentigo common?
hands, head, arms
What is lentigo simplex?
increase in melanocytes, unknown cause, UV light doesn’t affect
What is melasma associated with?
Pregnant, UV light exposure
What does melasma look like?
symmetrical hyperpigmentation of the face, UV light affects it.
What is a oral melanotic macule?
Brown asymptomatic macule in the mouth (freckle in the mouth)
Where’s the most common site of oral melanotic macule? what’s it called?
Lips
Labial melanotic macule
What does an oral melanotic macule look similar to?
Early melanoma
What is an oral melanoacanthoma?
Acquired pigmentation on buccal mucosa, most in african american, because of birth control common and traumatic injury.
Rapidly growing
What is worriesome about oral melanoacanthoma?
It grows rapidly like melanoma
What’s an acquired melanocytic nevus?
AKA Mole
benign localized proliferation of cells from the neural crest
What’s the most common all adult benign tumors?
acquired melanocytic nevus
What’s a congenital melanocytic nevus?
Birthmark mole
What is common in giant hairy nevus?
Hypertrichosis
What is a halo nevus?
Melanocytic nevus surrounded by hypopigmentation
Why do you see blue color in Blue nevus?
Tyndall effect (absorption of light wavelengths)
What is a blue nevus? size? shape
palatal benign proliferation of melanocytes
small symetrical
Where is blue nevus common?
palate
What is leukoplakia? (know this word for word)
Intraoral white plaque that does not rub off and cannot be identified as any well known entity
What is leukoplakia indicative of?!!!!! know this
pre-malignant lesion
How often is leukoplakia pre cancerous? how often is it just hyperkeratosis?
20%
80%
White lesions that rub off?
Materia alba White coated tongue (plaque coated) Candidiasis Burn Sloughing from tongue
How many leukoplakia patients smoke?
80%
What are the order for chance of cancer? least to greatest chance plakia’s???????????????????????
Leukoplakia
Erythroleukoplakia
Erythoplakia
PVL
What percentage of oral precancer starts as leukoplakia?
85%
What are the etiologies of leukoplakia?
Tobacco Alcohol Sanguinaria UV radiation Microorganisms Trauma
What is Sanguinaria and what can it cause?
Herbal extract in toothpaste and mouthwash
Leukoplakia in maxillary vestibule
If leukoplakia is found on the lower lip vermillion what likely caused it ?
UV radiation
What is proliferative verrucous leukoplakia?
A special high risk form of leukoplakia
What does proliferative verrucous leukoplakia look like?
multiple keratotic plaques with roughened surface projections
How many leukoplakias actually become Squamous cell carcinoma?
5% (becuase we catch it early)
What is erythroplakia?
Red patch that cannot be diagnosed as any other condition
Are erythroplakia’s benign?
No
What three areas get erythroplakia?
Floor of mouth
Ventral Tongue
Soft Palate
What does erythroplakia look like?
Red, well demarcated macule
How often is a biopsy necessary for erythroplakia?
All the time
How often is a biopsy necessary for erythroleukoplakia?
All the time
What does smokeless tobacco keratosis look like?
White leukoplakia, edematous white tissue where they place the tobacco, wrinkled skin.
If the smokeless tobacco keratosis doesn’t disappear in 6 weeks after quitting what should you do?
Biopsy it
What is oral submucous fibrosis?
Chronic, progressive, scarring, high-risk precancer because of Quid
What happens with Oral submucous fibrosis?
The elasticity of the mucosa disappears and they can’t open their mouth.
How many smokeless tobacco users get cancer?
1%
How many Quid users (oral submucous fibrosis) get cancer?
10%
What is nicotine stomatitis?
White keratotic change on the palate due to heat, numerous papules, looks like roughened palate
How much more likely are “reverse smokers” to get cancer?
15 times more likely
How long does nicotine stomatitis last if they quit smoking?
2 weeks
What is actinic keratosis? how common in white adults?
Scaly plaque cutaneous premalignant lesion from UV
50% of white adults
How many actinic keratosis progress to SCC (squamous cell carcinoma)? How long?
10% in two years
What is actinic cheilosis?
Same as the actinic keratosis but on the lip
What is squamous cell carcinoma?
squamous cells in the mucosa that become malignant
What percent of oral cancer is SCC?
95%
SCC tobacco what to know?
2packs per day: 5 X’s the risk
4 packs per day: 17 X’s the risk
SCC alcohol what to know?
Iron deficiency what to know?
1/3 of patients are heavy drinkers
Iron deficiency: Plummer Vinson syndrome
What areas (1-4) have most common SCC?
- Posterior lateral ventral tongue
- Floor of mouth
- Soft palate
- Gingiva
How does SCC spread metastatically?
Through the lymphatics (ipsilateral cervical lymph nodes)
What does TNM stand for?
size of TUMOR
involved lymph NODES
distant METASTASIS
Is clinical staging (TMN) a better prognostic indicator than histology?
YES
What is field cancerization?
the tendency to develop multiple mucosal cancers after having one already
What is verrucous carcinoma?
aka Snuff dippers cancer (mandibular usually)
White thick plaqure, well demarcated.
What to know about nasopharyngeal carcinoma causes?
What does it look like?
Ebstein barr virus Vit C deficiency Eating salt fish with N-nitro Tobacco (Huge swollen lymph nodes)
What to know about basal cell carcinoma?
Most common of all cancer
UV exposure as a child is worse.
What does basal cell carcinoma look like?
Ulcerated bump on the skin
superficial capillary
What’s the cure rate for Basal cell carcinoma?
98%
What is melanoma? What is a risk factor?
Malignant neoplasm of melonocyte origin
From intense UV sunburns
How common are deaths from Melanoma vs other cancer?
Melanoma is most likely to kill you
What is radical vs vertical cancer spreading?
Radical: spreads out flattly
Vertical: spreads down (becomes a tumor)
What is the ABCDE system for knowing the clinical features of melanoma?
Asymetry Border irregularity Color variation (darker is worse) Diameter (bigger than 6mm) Evolving lesions
What are the areas associated with worse prognosis of Melanoma?
BANS (back, arms, neck, scalp)
What’s the difference in Hecks disease and condyloma accuminata? Looks similar
Hecks: had it since childhood
Condyloma: sexually acquired later
What does verrucous carcinoma look like?
Cauliflower
What is actinic cheilosis indicative of? does it need a biopsy
Pre-cancer
Needs a biopsy
What does squamous cell carcinoma look like?
Irregular, ugly, non healing ulcer
What two cancers are found in the mouth?
Squamous cell carcinoma
Melanoma
What head and neck cancer is very rare in the mouth?
Melanoma
What does a primary herpetic infection look like?
Herpetic lesions all over the mouth
