DIFFERENTIAL DIAGNOSIS OF RED, WHITE AND PIGmented lesions

Question 1

Main causes of red lesions in the mouth?

Answer 1

• VASCULAR
• INFLAMMATORY
• PURPURA
• EROSIVE
• REACTIVE
• ATROPHIC
• NEOPLASMS

Question 2

Inflammatory causes of red white and pigmented lesions?

Answer 2

Question 3

what is this picture of?

Answer 3

Herpes simplex virus

Question 4

what is this?

Answer 4

Herpes zoster

Question 5

what does this show?

Answer 5

Candida

Question 6

what stain is this and what does it show?

Answer 6

PAS/d and it shows the candida hyphae

Question 7

What does this show?

Answer 7

Granular gingivitis

Question 8

what is this?

Answer 8

This is a reactive lesion

Pyogenic granuloma

Question 9

What are the erosive causes of red lesions?

Answer 9

Question 10

what does this show?

Answer 10

Aspirin burn

Question 11

what is this?

Answer 11

Pemphigoid lesion

Question 12

what is this?

Answer 12

Pemphigus

Question 13

what are the atrophic causes of red lesions?

Answer 13

Erythema migrans

Atrophic Lichen planus

Iron deficiency–> glossitis

Erythroplasia

Question 14

What is this?

Answer 14

Erythema migrans or Geographic tongue

Question 15

what is this?

Answer 15

Erythroplasia

Question 16

what causes purpura?

Answer 16

Trauma

Platelet disorders

Angina Bullosa heamorrhagica

Question 17

what is this?

Answer 17

Purpura

Question 18

what are the vascular anomalies which can cause red, white or pigmented lesions?

Answer 18

Lingual varices

telengiectasias

heamangiomas

Question 19

what is this?

Answer 19

HAEMANGIOMA/ TELENGIECTASIA

Question 20

what is a capillary heamangioma?

Answer 20

Capillary haemangioma may involve any intraoral area of mucosa with the mucosal aspect of the lower lip being a favourite site.

Direct pressure applied to the lesion will reveal blanching as opposed to the pigmented lesion.

Question 21

what are the neoplasms which cause red lesions?

Answer 21

SCC

Amelanotic melanoma

Karposis sarcoma

Question 22

Why do white patches look white?

Answer 22

usually due to a thickened keratin layer

Question 23

Label this layers of epithelium?

Answer 23

Question 24

what does this show?

Answer 24

hyper keratosis

Question 25

what are the main causes of white lesions? (COIN)

Answer 25

**C**ongenital **O**thers- Friction/burn **i**nfective/inflammatory **N**eoplastic

Question 26

infective causes fo white lesions?

Answer 26

Candida Hairy leukoplakia Syphylitic patch

Question 27

Non infective causes of white lesions

Answer 27

lichen planus Lupus erythematosis

Question 28

what is this?

Answer 28

hairy leaukoplakia (lateral borders of tongue)

Question 29

what are the congenital causes of white lesions?

Answer 29

WHITE SPONGE NAEVUS FORDYCE spots DYSKERATOSIS CONGENITA LEUKOEDEMA

Question 30

Other causes of white spot lesions?

Answer 30

burns scars skin graft cheek biting

Question 31

what is this?

Answer 31

frictional keratosis

Question 32

what causes intraoral pigmentation?

Answer 32

the pigmentation depends on the number of malanocytes at the basal layer or the amount of melanin produced by these melanocytes

Question 33

what is this?

Answer 33

normal melanocyte ( note it s at the basal layer)

Question 34

how can pigmentation arise?

Answer 34

Due to a pigmented foreign body more melanocytes more melanin produced by same number of melanocytes

Question 35

what are the sources of external pigment?

Answer 35

Amalgam tatoo heavy metal exposure intentional tatoo

Question 36

pigmentation secondary to a stimulus?

Answer 36

smoking drugs

Question 37

internal causes of pigmentation?

Answer 37

Oral melanotic macule (ephelis) Racial pigmentation Addisson’s Disease ACTH producing tumours Physiologic pigmentation of pregnancy (melasma) Peutz Jegher’s Syndrome Post inflammatory melanin incontinence

Question 38

what do these images show?

Answer 38

amalgam tatoo

Question 39

how does physiological pigmentation occur?

Answer 39

Due to an increase in melanin produced by melanocytes.

Question 40

what can cause the melanocytes to increase melanin production?

Answer 40

long lasting inflammation such as lichen planus, pemphigus and pemphigoid.

Question 41

what does this show?

Answer 41

More pigment but the same amount of melanocytes

Question 42

what is this?

Answer 42

oral melanotic macule. idiopathic in origin and the equivalent to a freckle. no malignancy transformation risk.

Question 43

what is racial pigmentation?

Answer 43

Pigmented mucosa is common in those with black skin.

Question 44

what does this show?

Answer 44

increased number and nest of melanocytes it is a neavus.

Question 45

what happens to the melancytes in oral melanoma?

Answer 45

Proliferation of malignant melanocytes along the junction between the epithelial and connective tissues & within the connective tissue It is a rare cancer though

Question 46

Showing a malignant melanoma histology

Answer 46

increased numbers of melanocytes and malignant cytology

Question 47

How does an oral melanoma present?

Answer 47

often asymptomatic slow growing brown or black patch asymmetrical borders or rapid growth, ulceration

Question 48

how do you manage oral melanoma?

Answer 48

wide excision radiotherapy and chemotherapy often ineffective often many metasis Prognosis is very poor - 15% survive 5 years

Question 49

what is Primary adrenal insufficiency (addisons)

Answer 49

• Autoimmune destruction * TB * Malignancy * Iatrogenic * Destruction of the adrenal gland--\>Decreased mineralo & gluco- corticoid levels Primary adrenal insufficiency is characterized by mineralocorticoid deficiency and by **hyperpigmentation** The most common causes (80%) is autoimmune adrenalitis

Question 50

what does this show?

Answer 50

Hyper pigmentation in addisons

Question 51

what would the investigations reveal in addisons?

Answer 51

elevated plasma ACTH synacthen test low serum sodium, and raised serum potassium adreno-cortical antibodies - often present in autoimmune adrenalitis abdominal film - calcified adrenals of tuberculosis chest radiology - tuberculous lesions

Question 52

what is Peutz Jegher’s Syndrome?

Answer 52

Genetically inherited syndrome Perioral pigmentation - multiple freckles Intraoral pigmentation- pigmentation may fade after puberty. Clinical diagnosis is important as there is a genetic risk of bowel cancer

Question 53

localised causes of pigmentation?

Answer 53

Question 54

what are the generalised causes of pigmentation?

Answer 54

Contraceptive pill, Antimalarials Hypoadrenalism, increased ACTH Drugs, smoking Post inflammatory Genetic--\>Racial ot Peutz Jeghers