DIFFERENTIAL DIAGNOSIS OF RED, WHITE AND PIGmented lesions Flashcards
Main causes of red lesions in the mouth?
- VASCULAR
- INFLAMMATORY
- PURPURA
- EROSIVE
- REACTIVE
- ATROPHIC
- NEOPLASMS
Inflammatory causes of red white and pigmented lesions?
what is this picture of?
Herpes simplex virus
what is this?
Herpes zoster
what does this show?
Candida
what stain is this and what does it show?
PAS/d and it shows the candida hyphae
What does this show?
Granular gingivitis
what is this?
This is a reactive lesion
Pyogenic granuloma
What are the erosive causes of red lesions?
what does this show?
Aspirin burn
what is this?
Pemphigoid lesion
what is this?
Pemphigus
what are the atrophic causes of red lesions?
Erythema migrans
Atrophic Lichen planus
Iron deficiency–> glossitis
Erythroplasia
What is this?
Erythema migrans or Geographic tongue
what is this?
Erythroplasia
what causes purpura?
Trauma
Platelet disorders
Angina Bullosa heamorrhagica
what is this?
Purpura
what are the vascular anomalies which can cause red, white or pigmented lesions?
Lingual varices
telengiectasias
heamangiomas
what is this?
HAEMANGIOMA/ TELENGIECTASIA
what is a capillary heamangioma?
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.
what are the neoplasms which cause red lesions?
SCC
Amelanotic melanoma
Karposis sarcoma
Why do white patches look white?
usually due to a thickened keratin layer
Label this layers of epithelium?
what does this show?
hyper keratosis
what are the main causes of white lesions? (COIN)
Congenital
Others- Friction/burn
infective/inflammatory
Neoplastic
infective causes fo white lesions?
Candida
Hairy leukoplakia
Syphylitic patch
Non infective causes of white lesions
lichen planus
Lupus erythematosis
what is this?
hairy leaukoplakia (lateral borders of tongue)
what are the congenital causes of white lesions?
WHITE SPONGE NAEVUS
FORDYCE spots
DYSKERATOSIS CONGENITA
LEUKOEDEMA
Other causes of white spot lesions?
burns
scars
skin graft
cheek biting
what is this?
frictional keratosis
what causes intraoral pigmentation?
the pigmentation depends on the number of malanocytes at the basal layer or the amount of melanin produced by these melanocytes
what is this?
normal melanocyte ( note it s at the basal layer)
how can pigmentation arise?
Due to a pigmented foreign body
more melanocytes
more melanin produced by same number of melanocytes
what are the sources of external pigment?
Amalgam tatoo
heavy metal exposure
intentional tatoo
pigmentation secondary to a stimulus?
smoking
drugs
internal causes of pigmentation?
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
what do these images show?
amalgam tatoo
how does physiological pigmentation occur?
Due to an increase in melanin produced by melanocytes.
what can cause the melanocytes to increase melanin production?
long lasting inflammation such as lichen planus, pemphigus and pemphigoid.
what does this show?
More pigment but the same amount of melanocytes
what is this?
oral melanotic macule.
idiopathic in origin and the equivalent to a freckle.
no malignancy transformation risk.
what is racial pigmentation?
Pigmented mucosa is common in those with black skin.
what does this show?
increased number and nest of melanocytes
it is a neavus.
what happens to the melancytes in oral melanoma?
Proliferation of malignant melanocytes along the junction between the epithelial and connective tissues & within the connective tissue
It is a rare cancer though
Showing a malignant melanoma histology
increased numbers of melanocytes and malignant cytology
How does an oral melanoma present?
often asymptomatic
slow growing brown or black patch
asymmetrical borders
or rapid growth, ulceration
how do you manage oral melanoma?
wide excision
radiotherapy and chemotherapy often ineffective
often many metasis
Prognosis is very poor - 15% survive 5 years
what is Primary adrenal insufficiency (addisons)
• 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
what does this show?
Hyper pigmentation in addisons
what would the investigations reveal in addisons?
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
what is Peutz Jegher’s Syndrome?
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
localised causes of pigmentation?
what are the generalised causes of pigmentation?
Contraceptive pill, Antimalarials
Hypoadrenalism, increased ACTH
Drugs, smoking
Post inflammatory
Genetic–>Racial ot Peutz Jeghers
