Chapter 10 - Part 2 Flashcards
What term describes a chronic, progressive, scarring, high risk precancerous condition of the oral mucosa?
Oral submucous fibrosis
What is oral sumbucous fibrosis linked with?
Linked to chronic placement of betel quid of paan
Where is oral submucous fibrosis primarily seen?
In India
What are some of the ingredients in betel quid?
Areca nut, slaked lime, betel leaf, tobacco and sweeteners = euphoria
What is oral submucous fibrosis characterized by?
Mucosal rigidity caused by a thicer connective tissue –> surface is typically white
What sites are most commonly affected by oral submucous fibrosis?
Buccal mucosa, retromolar areas and soft palate
Does oral submucous fibrosis lesions regress with habit cessation?
No
Why is frequent follow up of oral submucous fibrosis mandatory?
Because 10% undergo malignant transformation
What term describes a white keratotic change on the palate due to long term exposure to heat?
Nicotine stomatitis
In general, is nicotine stomatitis considered a premalignant lesion?
No, but when due to reverse smoking (called reverse smoker’s palate), there is a significant potential for malignant transformation so biopsy is required
In what population is nicotine stomatitis common?
White males, older than 45
What are the numerous, slightly elevated papules with punctate red centers associated with nicotine stomatitis?
Represent inflamed minor salivary glands and their ductal orifices
Will nicotine stomatitis regress after habit cessation?
Yes, it is completely reversible
What term describes a common cutaneous , scaly irregular plaque?
Actinic keratosis
What causes actinic keratosis?
Caused by cumulative UV radiation
In what population is actinic keratosis common?
Elderly, seldom found in patients younger than 40
Is actinic keratosis premalignant?
Yes, so it should be destroyed or excised
About how many cases of actinic keratosis will progress to SCCA in 2 years?
About 10% will progress to SCCA in 2 years
What term describes a common alteration of the lower lip, caused by chronic long term exposure to UV light?
Actinic cheilosis
In what population is actinic cheilosis common?
Men 10:1, and rare in people younger than 45
What are the earliest clinical changes in actinic cheilosis?
Atrophy of the lower lip vermilion border, characterized by a smooth surface and blotchy pale areas, and blurring of the margin between vermilion zone and the cutaneous portion of the lip
Further progression of actinic cheilosis causes what clinical changes?
Scaly areas, that can lead to ulcerations, which suggest transformation into SCCA
Is actinic cheilosis reversible?
No, but patients should be instructed to use lip balms with sunscreens to prevent further damage
When should a lesion of actinic cheilosis be submitted for biopsy?
If it is indurated, has a thickening (leukoplakia), or if there is ulceration
How many patients will develop SCCA from actinic cheilosis?
10% of patients will develop SCCA
What term describes a self, limiting epithelial proliferation that appears as a firm, well demarcated, painless, dome shaped nodule withe a central plug of keratin?
Keratoacanthoma
What is another name for keratoacanthoma?
Squamous cell carcinoma, keratoacanthoma type
What are the 3 phases of a keratoacanthoma?
Growth (rapidly grows up to 2 cm in 6 weks), then is stationary, then involution (within 1 year of onset) – despite the involution, surgical excision is recommended
How many American’s develop squamous cell carcinoma?
1/3
How many of the 1/3 american’s that develop SCCA will survive?
2/3
What is the cause of SCCA?
The cause of SCCA is multifactorial; tobacco, betel quid, alcohol, phenolic agents, radiation, iron deficiency, vitamin A deficiency, syphilis, oncogenic viruses, immunosuppression, oncogenes
True or False: Pipe and cigar smoking carries a greater oral cancer risk than cigarette smoking?
True, but the greatest risk comes with reverse smoking
What is a smoker’s risk for oral SCCA dependent on?
Relative risk that is dose dependent, and increases the longer a person smokes
Can alcohol cause SCCA?
It is uncertain, but in combination with tobacco it is a significant risk factor for SCCA
Why is does an Iron deficiency put patients at an increased risk of SCCA, and what syndrome is associated with iron deficiency?
Impaired cell mediated immunity, so their body doesn’t catch the cancerous cells, and Plummer-Vinson syndrome
What syndrome is associated with keratoacanthoma?
Muir-Torre syndrome, hereditary predisposition for multiple lesions
What is the most common site of intraoral SCCA?
Posterior lateral, ventral tongue, then the floor of mouth, soft palate and gingiva
Generally, are squamous cell carcinomas painless?
Yes!
Why are oropharyngeal SCCA’s usually not discovered until they are metastasized?
Because they are so far posterior, the patient is usually unaware of its presence, until it has metastasized
How does SCCA metastasize?
Via lymphatics to ipsilateral cervical lymph nodes
What changes will occur in the lymph nodes if SCCA has metastasized?
Nodes will present as firm to stony hard, painless, enlarged and fized
Where can distant metastasis of SCCA be found commonly?
Lungs, liver and bones
What is the best best indicator of patient prognosis in SCCA?
TNM staging
TNM staging is a better prognostic indiacator than histologic grading
Describe TNM staging
T= size of primary local tumor in cm N = involvement of local lymph nodes M= distant metastasis
x= no info 0= no evidence
How is lip SCCA treated?
Wedge resection, and has a better survival rate than oral SCCA
How is oral SCCA treated?
Wide surgical excision and/or radiation therapy, and/or chemotherapy
When do patients with oral SCCA recieve radical neck dissection?
When intraoral SCCA tumors are larger than 3 mm deep
Are patients with one carcinoma of the mouth or throat at an increased risk for an additional SCCA?
Yes
Concurrently (synchronous)
Different time (metachronous)
What term describes a tendency toward development of multiple mucosal cancers?
Field cancerization
What term describes a cancer caused by smokeless tobacco?
Verrucous carcinoma
What is another name for verrucous carcinoma?
Snuff Dipper’s cancer
What is verrucous carcinoma a variant of?
A low grade variant of oral SCCA
Where is verrucous carcinoma commonly found?
Mandibular vestibule, and gingiva
What is unique about the microscopic appearance of verrucous carcinoma?
It has a deceptively benign microscopic appearance
Why is adequate sampling of verrucous carcinoma important?
Up to 20% of verrucous carcinomas have an SCCA developing within it
How is verrucous carcinoma treated?
Surgical excision without neck dissection
What term describes a group of malignancies that arise from the lining epithelium of the nasopharynx?
Nasopharyngeal carcinoma
What population is most commonly affected by nasopharyngeal carcinoma?
Chinese men, age 50
What are some possible contributory factors associated with Nasopharyngeal carcinoma?
EBV infection, Vitamin C deficiency, consumption of salt fish with N-nitrosamine, tobacco (+/-)
Why is the first sign of nasopharyngeal carcinoma cervical lymph node metastasis?
Because it goes missed because it is difficult to visualize the entire nasopharyngeal tract
What term describes a locally invasive and slowly spreading epithelial malignancy?
Basal cell carcinoma
True or False: Basal cell carcinoma is the most common of all cancers
True
What causes nasal cell carcinoma?
UV radiation (frequent sunburns and freckling in childhood increases risk)
What is the most common form of basal cell carcinoma?
Nodular (noduloulcerative)
What is the clinical presentation of nodular basal cell carcinoma?
Begins as a firm, painless papule that develops a central depression and has one or more telangiectatic blood vessels
What is the risk of metastasis and reccurence of basal cell carcinoma?
Metastasis is extremely rare, and recurrence is uncommon when properly treated
What does treatment depend on with basal cell carcinoma?
Size and location of the lesion –> Mohs micrographic surgery
What term describes a malignant neoplasm of melanocytic origin?
Melanoma
Where can melanoma develop?
Anywhere melanocytes are present, but usually on the skin
What is the cause of melanoma?
Acute sun exposure
What factors increase a person’s risk for melanoma?
Family hx of disease, fair complexion, light hair, hx of painful/blistering sunburns in childhood
Melanoma is the _______ most common skin cancer, but accounts for the _____ deaths
Melanoma is the 3rd most common skin cancer, but accounts for the most deaths
Why is it important to biopsy pigmented macules in the oral cavity?
Because 1/3 or persons with oral melanoma have a history of pigmented macule in the region of the melanoma
What two directional patterns of growth does melanoma exhibit?
Radical (horizontal through basal layer) and vertical (invade underlying CT)
What is ABCDE stand for?
Asymmetry, border irregularity, color variation, diameter greater than 6 mm, evolving lesion
What correlates with prognosis in melanoma?
Depth of invasion (use’s Clark’s classification) - any invasion more than 0.5 mm in oral mucosa melanoma has poor prognosis
Interesting fact: Melanomas are traditionally considered radioresistant
Yep
What areas are associated with a worse prognosis in melanoma?
BANS
Interscapular area of the back, posterior upper arm, posterior and lateral neck, scalp
What is the prognosis for oral melanoma and why?
EXTREMELY poor, 5 year survival is 15-20% due to inability for wide resection and a tendency for early hematogenous metastasis
What do patients usually die from in melanoma?
Distant metastasis rather than lack of local control
