Chapter 10 Flashcards
1
Q
What is the term for a benign proliferation of stratified squamous epithelium?
A
Squamous papilloma.
2
Q
What type of virus causes squamous papilloma?
A
DNA HPV types 6 & 11.
3
Q
Define Virulance and Infectivity.
A
Virulence = Ability of virus to overcome body’s defenses & cause disease
Infectivity = Ability to establish infection from one person to another horizontally
4
Q
What is the differential Dx for squamous papilloma?
A
Verruca vulgaris, Condyloma acuminatum, and verruciform xanthoma.
5
Q
What is the likely Dx?
A
Squamous papilloma
6
Q
What is the likely Dx?
A
Squamous papilloma
7
Q
What is the likely Dx?
A
Squamous papilloma
8
Q
What type of virus causes Verruca vulgaris?
A
HPV 2, 4, 6, 40. NOTE most common on skin.
9
Q
What viruses cause condyloma acuminatum? What is another name for it, and how is it contracted?
A
HPV 6, 11, 16, 18, 31. Also called venereal wart and is and STD.
10
Q
What is the likely Dx?
At what stage of life would this likely appear?
A
Multifocal epithelial hyperplasia AKA Heck’s disease. Appears in childhood.
11
Q
What viruses cause multifocal epithelial hyperplasia?
A
HPV 13 & 32.
12
Q
What type of disease is caused by the DNA poxvirus?
What will the histology look like?
A
Molluscum contagiosum.
Histology will contain molluscum bodies AKA Henderson-Paterson bodies.
13
Q
What is the term for an acquired, benign proliferation of epidermal basal cells of unknown etiology?
A
Seborrheic Keratosis.
14
Q
What is the likely Dx?
A
Molluscum contagiosum.
15
Q
What is the likely Dx?
A
Seborrheic Keratosis. NOTE, will not occur in the mouth.
16
Q
What is the term for the sudden appearance of numerous seborrheic keratoses with puritus and what is it associated with?
A
Leser-Trelat sign, it is an indication of internal malignancy.
17
Q
What is an ephelis?
A
A freckle. NOTE become more pronounced with sun exposure.
18
Q
What is the term for a brown macule resulting from chronic UV light damage to skin?
A
Actinic lentigo. NOTE no change of intensity with UV expsure.
19
Q
What is the likely Dx?
A
Ephelis.
20
Q
What is the likely Dx?
A
Actinic lentigo.
21
Q
What is the term for a benign cutaneous melanocytic hyperplasia?
A
Lentigo simplex.
22
Q
What is the likely Dx?
A
Lentigo simplex. NOTE does not change with sunlight.
23
Q
What is the term for an acquired, symmetrical, hormonally-driven hyperpigmentation of the sun-exposed skin of the face?
What is it commonly associated with?
A
Melasma.
Pregnancy.
24
Q
What is the likely Dx?
A
Melasma.
25
What is the term for the oral counter part of an ephelis?
Labial melanotic macule or oral melanotic macule.
26
What is the most common site for an oral melanotic macule?
Vermilion zone of the lower lip.
27
Why is it important to biopsy an oral melanotic macule?
Because the non malignant transformation is potential, but clinically cannot be distinguished from early melanoma.
28
What is the likely Dx?
Labial melanotic macule.
29
What is the likely Dx?
Oral melanotic macule.
30
What causes an oral melanotic macule?
Brown asympomatic macule produced by a focal increase in melanin deposition.
31
What is an acquired pigmentation of the oral mucosa, characterized by dendritic melanocytes throughout the epithelium?
Oral melanoacanthoma.
32
What is the likely Dx?
Oral melanoacanthoma.
33
What population will have a presence of oral melanoacanthoma most often?
What does it seem to be caused by?
African American and females due to hormones.
Seems to be caused by trauma.
34
What is the common name for a nevus?
Mole.
35
What is the most commonly recognized nevus?
Acquired melanocytic nevus.
36
What is the likely Dx?
Aqcuired melanocytic nevus.
37
What is the term for a benign, localized proliferation of cells from the neural crest?
Acquired melanocytic nevus.
38
Acquired melanocytic nevus has a predilection for where?
Palate.
39
What is the histology of an acquired melanocytic nevus?
The superficial cells are organized into small, round aggregates termed Theques.
40
What is the likely Dx?
Intraoral melanocytic nevus.
41
What is a common feature of a congenital melanocytic nevus?
Hypertrichosis (excess hair)
42
What is the likely Dx?
Halo Nevus.
43
What is the likely Dx?
Blue nevus.
44
What are the two forms of a blue nevus?
_Common:_ 2nd most frequent nevus in oral cavity. Predilection for dorsa of hands and feet, scalp, face. Occurs in children, less than 1 cm in diameter.
_Cellular:_ 50% seen on buttock, slow growing.
45
What causes a blue nevus to appear blue?
Tyndall effect. Melanin particles deep to the surface.
46
What is an intraoral white leasion that does not rub off?
Leukoplakia.
47
What are some white lesions that can be removed?
Materia alba, white coated tongue, burn, pseudomembranous candidiasis, sloughing from tooth paste.
48
What is the etiology of leukoplakia?
Tobacco, alcohol (worse than tobacco), sanguinaria, UV radiation, MOs, trauma.
49
Where are most leukoplakias found?
Lip vermilion, buccal mucosa, gingiva.
high risk sites are lip vermilion, lateral/ventral tongue, floor of mouth.
50
What are lesions that can demonstrate scattered red patches?
Erythroplakia.
51
What is the order of risk for the "plakias?"
Leukoplakia, erythroleukoplakia, erythroplakia, proliferative verrucous leukoplakia.
52
What is the special, high risk form of leukoplakia?
Proliferative verrucous leukoplakia.
53
What is the likely Dx?
Proliferative verrucous leukoplakia.
54
Define the following histologies of leukoplakia: Hyperkeratosis, hyperparakeratosis, hyperorthokeratosis, acanthosis.
_Hyperkeratosis:_ Thickened keratin layer
_Hyperparakeratosis:_ No granular cell layer; nuclei are retained
_Hyperorthokeratosis:_ Granular cell layer; nuclei are lost (Orth-No-Keratosis)
_Acanthosis:_ Thickened spinous layer
55
What do the following presentations mean with biopsies taken? Mild dysplasia, moderate dysplasia, severe dysplasia, and carcinoma in situ:
_Mild dysplasia:_ Alterations are limited to the lower 1/3.
_Moderate dysplasia:_ Alterations are limited to the lower 1/2.
_Severe dysplasia:_ Alterations are present above lower 1/2
_Carcinoma in situ:_ Alterations are present throughout epithelium.
56
When do you have to remove the entire leukoplakia?
When it is moderate dysplasia or worse.
57
What are the most common locations for erythroplakia?
Floor of mouth, ventral tongue, and soft palate.
58
What often developes on the oral epithelium from smokeless tobacco?
Smokeless tobacco keratosis.
59
What is the likely Dx?
Smokeless tobacco keratosis.
60
What are the three types of smokeless tobacco?
Chewing tobacco, moist snuff, dry snuff.
61
What is a frequent finding with smokeless tobacco?
Halitosis.
62
What is the term for chronic, progressive, scarring, high-risk precancerous condition of the oral mucosa?
What is it associated with?
Oral submucous fibrosis.
Associated with betel quid or paan.
63
What are the compents of quid?
Areca nut, slaked lime, betel leaf.
64
What is the likely Dx?
Oral submucous fibrosis.
65
What is the first cheif complaint associated with oral submucous fibrosis?
Will the lesions go away?
Trismus and mucosal pain from eating spicy foods.
Lesion does not regress with habit cessation.
66
What percent of oral submucous fibrosis undergo malignant transformation?
10%
67
What is the likely Dx?
Nicotine stomatitis.
68
What is the difference in malignant transformation between nicotine stomatitis and reverse smoking?
Which is reversible?
Nicotine stomatitis is not premalignant while reverse smoking is.
Only nicotine stomatitis is reversible wintin 2 weeks.
69
What is the likely Dx?
Actinic keratosis.
70
What is the cause of actinic keratosis?
Cummulative UV radiation.
71
What percent of actinic keratoses progress to SCCA?
10% in 2 years.
72
What is the likely Dx?
Actinic cheilosis.
73
What percent of patients with actinic ceilosis will develop SCCA?
10%.
74
What is the likely Dx?
Keratoacanthoma.
75
Cancer accounts for what percentage of deaths in the US? What percentage of that is oral cancer? What percentage of the oral cancer is SCCA?
20% of all deaths. Oral cancer accounts for 3%. 95% of oral cancer is SCCA.
76
If you smoke 2ppd or 4ppd what is your relative risk for developing SCCA?
2ppd is 5x and 4 ppd is 17x.
77
What is the syndrome with sever, chronic iron defficiency that puts an individual at increased risk for SCCA?
Plummer-Vinson syndrome.
78
What are the most common sites of SCCA in the mouth?
1- Posterior, lateral, ventral tongue. 2- Floor of mouth. 3- Soft palate. 4- Gingiva.
79
How does metastatic spread of SCCA occur?
Through the lymphatics.
80
How will lymph nodes present when metastatic spread is present?
Firm to stony hard, painless, enlarged, fixed.
81
Where is metastatic spread most commonly found?
Lungs, Liver, and bones.
82
Explain the TNM staging system of metastatic spread.
T- Tumor size.
N- involvement of local lymph node
M- Distant metastasis
If letter is followed by and "x" it means there is no available information and followed by an "o" it means there is no evidence of primary tumor.
83
Which SCCA has a better survival rate, lip or oral cavity?
Lip.
84
How is lip carcinoma typically treated?
Wedge resection with 10% reoccurance and 100% 5 year survival.
85
When refereing to SCCA what does syncronous and metachronous mean?
_Syncronous_ means addition SCC are happening concurrently and _metachronous_ means additional SCC are happening at a different time.
86
What is the term field cancerization referring to?
Development of multiple mucosal cancers.
87
What is the form of cancer that will have the clinical presentation of cauliflower and is considered a low grade variant of oral SCC?
Verrucous carcinoma AKA snuff dipper's cancer.
88
When a patient presents with SCCA, when will they have to have a neck dissection?
When the intraoral tumors are larger then 3mm in depth.
89
What is the likely Dx?
Verrucous carcinoma
90
What percent of verrucous carcinoma have SCCA developing?
20%.
91
What is the order(from most to least) of potential malignant transformations?
Proliferative verrucous leukoplakia.
Nicotine Stomatitis in reverse smokers.
Erythroplakia.
Oral submucous fibrosis.
Erythroleukoplakia.
Granular leukoplakia.
Actinic cheilosis.
92
What is the term used for a group of malignancies that arise from the lining epithelium of the nasopharynx?
Nasopharyngeal carcinoma.
93
What is the difference between carcinoma and sarcoma?
Carcinoma is epithelial derived and sarcoma is mesenchymal derived.
94
What type of cancer is most prevalent in Chinese men?
Nasopharyngeal carcinoma.
95
What are some contributory factors for develpoing nasopharyngeal carcinoma?
EBV infection, Vitamin C deficiency, N-nitrosamines.
96
What is the first sign of disease in nasopharyngeal carcinoma?
Cervical lymph node metastasis.
97
What is the most common of all cancers?
Basal cell carcinoma.
98
What percent of basal cell carcinomas are found in the head and neck?
80%.
99
What is the likely Dx?
Basal cell carcinoma.
100
What is the most common form of basal cell carcinoma?
Nodular.
101
What is the name for the small, red blood vessel that will feed a basal cell carcinoma?
Talandactasia.
102
How common is metastasis of basal cell carcinoma?
Extremely rare.
103
What is mohs micrographic surgery?
Uses frozen sections to evaluate margins during surgery.
104
What is the term for a malignant neoplasm of melanocytic origin?
Melanoma.
105
What is the major causative factor of melanoma?
UV radiation.
106
What is the likely Dx?
Melanoma.
107
What is the third most common skin cancer, but accounts for the most deaths?
Melanoma.
108
What is the likely Dx?
Oral melanoma.
109
What are the two directional patterns of growth for melanoma and explain them:
_Radical-_ malignant melanocytes spread horizontally through basal layer.
_Vertical-_ Malignant cells invade underlying connective tissue.
110
What is the size of the margin when excising melanoma?
3-5 cm margin.
111
Can melanoma be treated with rediotherapy?
No.
112
What is the system used to help distinguish between melanoma and melanocytic nevus?
A- Asymmetry
B- Border irregularity
C- Color variation
D- Diameter greater than 6mm
E- evolving lesions (sudden increase in size)
113
REVIEW:
Ulceration is an adverse prognostic indicator for cutaneous melanoma.
Ulceration had not been proven to be a prognostic indicator in mucosal melanoma.
Any invasion more than 0.5mm in oral mucosa melanoma has poor prognosis. (This is because mucosa is so thin and is close to bone.)
REVIEW:
Ulceration is an adverse prognostic indicator for cutaneous melanoma.
Ulceration had not been proven to be a prognostic indicator in mucosal melanoma.
Any invasion more than 0.5mm in oral mucosa melanoma has poor prognosis. (This is because mucosa is so thin and is close to bone.)
114
What are the areas associated with a worse prognosis with melanoma?
B- Interscapular are of the back.
A- Posterior upper arm
N- Posterior and lateral neck.
S- Scalp.
115
What is the 5 year survival for melanoma?
15-20%.
116
What are the TNM classifications for stages I-IV?
I- T1 N0 M0
II- T2 N0 M0
III- T3 N0 M0 or T N1 M0
IV- Any T4, Any M, any N3
