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Oral Pathology - My deck > Chapter 10 - Part 2 > Flashcards

Chapter 10 - Part 2 Flashcards

1
Q

What term describes a chronic, progressive, scarring, high risk precancerous condition of the oral mucosa?

A

Oral submucous fibrosis

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2
Q

What is oral sumbucous fibrosis linked with?

A

Linked to chronic placement of betel quid of paan

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3
Q

Where is oral submucous fibrosis primarily seen?

A

In India

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4
Q

What are some of the ingredients in betel quid?

A

Areca nut, slaked lime, betel leaf, tobacco and sweeteners = euphoria

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5
Q

What is oral submucous fibrosis characterized by?

A

Mucosal rigidity caused by a thicer connective tissue –> surface is typically white

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6
Q

What sites are most commonly affected by oral submucous fibrosis?

A

Buccal mucosa, retromolar areas and soft palate

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7
Q

Does oral submucous fibrosis lesions regress with habit cessation?

A

No

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8
Q

Why is frequent follow up of oral submucous fibrosis mandatory?

A

Because 10% undergo malignant transformation

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9
Q

What term describes a white keratotic change on the palate due to long term exposure to heat?

A

Nicotine stomatitis

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10
Q

In general, is nicotine stomatitis considered a premalignant lesion?

A

No, but when due to reverse smoking (called reverse smoker’s palate), there is a significant potential for malignant transformation so biopsy is required

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11
Q

In what population is nicotine stomatitis common?

A

White males, older than 45

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12
Q

What are the numerous, slightly elevated papules with punctate red centers associated with nicotine stomatitis?

A

Represent inflamed minor salivary glands and their ductal orifices

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13
Q

Will nicotine stomatitis regress after habit cessation?

A

Yes, it is completely reversible

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14
Q

What term describes a common cutaneous , scaly irregular plaque?

A

Actinic keratosis

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15
Q

What causes actinic keratosis?

A

Caused by cumulative UV radiation

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16
Q

In what population is actinic keratosis common?

A

Elderly, seldom found in patients younger than 40

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17
Q

Is actinic keratosis premalignant?

A

Yes, so it should be destroyed or excised

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18
Q

About how many cases of actinic keratosis will progress to SCCA in 2 years?

A

About 10% will progress to SCCA in 2 years

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19
Q

What term describes a common alteration of the lower lip, caused by chronic long term exposure to UV light?

A

Actinic cheilosis

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20
Q

In what population is actinic cheilosis common?

A

Men 10:1, and rare in people younger than 45

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21
Q

What are the earliest clinical changes in actinic cheilosis?

A

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

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22
Q

Further progression of actinic cheilosis causes what clinical changes?

A

Scaly areas, that can lead to ulcerations, which suggest transformation into SCCA

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23
Q

Is actinic cheilosis reversible?

A

No, but patients should be instructed to use lip balms with sunscreens to prevent further damage

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24
Q

When should a lesion of actinic cheilosis be submitted for biopsy?

A

If it is indurated, has a thickening (leukoplakia), or if there is ulceration

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25
Q

How many patients will develop SCCA from actinic cheilosis?

A

10% of patients will develop SCCA

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26
Q

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?

A

Keratoacanthoma

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27
Q

What is another name for keratoacanthoma?

A

Squamous cell carcinoma, keratoacanthoma type

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28
Q

What are the 3 phases of a keratoacanthoma?

A

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

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29
Q

How many American’s develop squamous cell carcinoma?

A

1/3

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30
Q

How many of the 1/3 american’s that develop SCCA will survive?

A

2/3

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31
Q

What is the cause of SCCA?

A

The cause of SCCA is multifactorial; tobacco, betel quid, alcohol, phenolic agents, radiation, iron deficiency, vitamin A deficiency, syphilis, oncogenic viruses, immunosuppression, oncogenes

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32
Q

True or False: Pipe and cigar smoking carries a greater oral cancer risk than cigarette smoking?

A

True, but the greatest risk comes with reverse smoking

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33
Q

What is a smoker’s risk for oral SCCA dependent on?

A

Relative risk that is dose dependent, and increases the longer a person smokes

34
Q

Can alcohol cause SCCA?

A

It is uncertain, but in combination with tobacco it is a significant risk factor for SCCA

35
Q

Why is does an Iron deficiency put patients at an increased risk of SCCA, and what syndrome is associated with iron deficiency?

A

Impaired cell mediated immunity, so their body doesn’t catch the cancerous cells, and Plummer-Vinson syndrome

36
Q

What syndrome is associated with keratoacanthoma?

A

Muir-Torre syndrome, hereditary predisposition for multiple lesions

37
Q

What is the most common site of intraoral SCCA?

A

Posterior lateral, ventral tongue, then the floor of mouth, soft palate and gingiva

38
Q

Generally, are squamous cell carcinomas painless?

A

Yes!

39
Q

Why are oropharyngeal SCCA’s usually not discovered until they are metastasized?

A

Because they are so far posterior, the patient is usually unaware of its presence, until it has metastasized

40
Q

How does SCCA metastasize?

A

Via lymphatics to ipsilateral cervical lymph nodes

41
Q

What changes will occur in the lymph nodes if SCCA has metastasized?

A

Nodes will present as firm to stony hard, painless, enlarged and fized

42
Q

Where can distant metastasis of SCCA be found commonly?

A

Lungs, liver and bones

43
Q

What is the best best indicator of patient prognosis in SCCA?

A

TNM staging

TNM staging is a better prognostic indiacator than histologic grading

44
Q

Describe TNM staging

A 
T= size of primary local tumor in cm
N = involvement of local lymph nodes
M= distant metastasis
x= no info
0= no evidence
45
Q

How is lip SCCA treated?

A

Wedge resection, and has a better survival rate than oral SCCA

46
Q

How is oral SCCA treated?

A

Wide surgical excision and/or radiation therapy, and/or chemotherapy

47
Q

When do patients with oral SCCA recieve radical neck dissection?

A

When intraoral SCCA tumors are larger than 3 mm deep

48
Q

Are patients with one carcinoma of the mouth or throat at an increased risk for an additional SCCA?

A

Yes

Concurrently (synchronous)

Different time (metachronous)

49
Q

What term describes a tendency toward development of multiple mucosal cancers?

A

Field cancerization

50
Q

What term describes a cancer caused by smokeless tobacco?

A

Verrucous carcinoma

51
Q

What is another name for verrucous carcinoma?

A

Snuff Dipper’s cancer

52
Q

What is verrucous carcinoma a variant of?

A

A low grade variant of oral SCCA

53
Q

Where is verrucous carcinoma commonly found?

A

Mandibular vestibule, and gingiva

54
Q

What is unique about the microscopic appearance of verrucous carcinoma?

A

It has a deceptively benign microscopic appearance

55
Q

Why is adequate sampling of verrucous carcinoma important?

A

Up to 20% of verrucous carcinomas have an SCCA developing within it

56
Q

How is verrucous carcinoma treated?

A

Surgical excision without neck dissection

57
Q

What term describes a group of malignancies that arise from the lining epithelium of the nasopharynx?

A

Nasopharyngeal carcinoma

58
Q

What population is most commonly affected by nasopharyngeal carcinoma?

A

Chinese men, age 50

59
Q

What are some possible contributory factors associated with Nasopharyngeal carcinoma?

A

EBV infection, Vitamin C deficiency, consumption of salt fish with N-nitrosamine, tobacco (+/-)

60
Q

Why is the first sign of nasopharyngeal carcinoma cervical lymph node metastasis?

A

Because it goes missed because it is difficult to visualize the entire nasopharyngeal tract

61
Q

What term describes a locally invasive and slowly spreading epithelial malignancy?

A

Basal cell carcinoma

62
Q

True or False: Basal cell carcinoma is the most common of all cancers

A

True

63
Q

What causes nasal cell carcinoma?

A

UV radiation (frequent sunburns and freckling in childhood increases risk)

64
Q

What is the most common form of basal cell carcinoma?

A

Nodular (noduloulcerative)

65
Q

What is the clinical presentation of nodular basal cell carcinoma?

A

Begins as a firm, painless papule that develops a central depression and has one or more telangiectatic blood vessels

66
Q

What is the risk of metastasis and reccurence of basal cell carcinoma?

A

Metastasis is extremely rare, and recurrence is uncommon when properly treated

67
Q

What does treatment depend on with basal cell carcinoma?

A

Size and location of the lesion –> Mohs micrographic surgery

68
Q

What term describes a malignant neoplasm of melanocytic origin?

A

Melanoma

69
Q

Where can melanoma develop?

A

Anywhere melanocytes are present, but usually on the skin

70
Q

What is the cause of melanoma?

A

Acute sun exposure

71
Q

What factors increase a person’s risk for melanoma?

A

Family hx of disease, fair complexion, light hair, hx of painful/blistering sunburns in childhood

72
Q

Melanoma is the _______ most common skin cancer, but accounts for the _____ deaths

A

Melanoma is the 3rd most common skin cancer, but accounts for the most deaths

73
Q

Why is it important to biopsy pigmented macules in the oral cavity?

A

Because 1/3 or persons with oral melanoma have a history of pigmented macule in the region of the melanoma

74
Q

What two directional patterns of growth does melanoma exhibit?

A

Radical (horizontal through basal layer) and vertical (invade underlying CT)

75
Q

What is ABCDE stand for?

A

Asymmetry, border irregularity, color variation, diameter greater than 6 mm, evolving lesion

76
Q

What correlates with prognosis in melanoma?

A

Depth of invasion (use’s Clark’s classification) - any invasion more than 0.5 mm in oral mucosa melanoma has poor prognosis

77
Q

Interesting fact: Melanomas are traditionally considered radioresistant

A

Yep

78
Q

What areas are associated with a worse prognosis in melanoma?

A

BANS

Interscapular area of the back, posterior upper arm, posterior and lateral neck, scalp

79
Q

What is the prognosis for oral melanoma and why?

A

EXTREMELY poor, 5 year survival is 15-20% due to inability for wide resection and a tendency for early hematogenous metastasis

80
Q

What do patients usually die from in melanoma?

A

Distant metastasis rather than lack of local control

Oral Pathology - My deck (22 decks)

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