Epithelial Flashcards
Frictional keratosis
etiology: Chronic trauma- tooth/denture
Sites: many
age:-
gender: -
appearance: on palpation - smooth to rough, irregular and lathery in consistency
Tobacco keratosis
Etiology: smoking
Site: posterior lateral/ventral tongue, retromolar area, FOM
Age: middle aged males
Appearance: range from smooth white lesions to verruciform, can be benign, malignant, premalignant.
Nicotinic Stomatitis
Etiology: heavy pipe smoking, sometimes due to very hot coffee/tea
Site: palate
Age: adult males
Appearance: white palate with elevated papules with red spots (red spots are dialated salivary gland ducts)
Smokeless tobacco keratosis
Etiology: smokeless tobacco - more nicotine into the bloodstream than cigarettes.
Site:buccal/labial vestibule and gingiva
Age: 18yrs
Gender: young blue collar white males
Appearance: folded white lesions, low potential for malignant transformation, biopsy
Direct contact white patches
Etiology: holding mouthwash, alcohol (PIC), cinnamon candy, lozenges, nicorette microtabs, sunflower seeds against oral mucosa
Appearance: leukoplakia
Idiopathic Leukoplakia (keratosis)
Etiology: non-smokers, no irritation
Site: the most dangerous is FOM. only 10% of leukoplakia occurs in FOM but they are 42% of the time premalignant or malignant
Age: middle aged females
Appearance: leukoplakia, 80% benign, can be transformed to epithelial dysplasia (17%)- may reverse to normal) or SCC (3%)
TUGSE
Etiology: mostly trauma history
Site: 64% on the posterior lateral tongue, also on BM and Lips
Age: any age, including infants (Rita Fede)
Gender: more in males
Appearance:single ulcer, could be pseudomembrane, asymptomatic typically, could be rolled boarders and mistaken for SCC, 12-30 recurrence rate
SCC - general info
Etiology: Tobacco is 75%, 22% HPV (posterior mouth and base of the tongue)
Site: lateral and ventral tongue, FOM and gingiva. Most are posterior, 10% are anterior
Age: over 55
Gender: men
Appearance: Non-healing ulcer, red or red and white lesion
Frequency: most common malignant neoplasm of the mouth - 90% of all malignant neoplasms in oral cavity
Note: tobacco-associated is anterior mouth, poor prognosis, black males in 50-60s. HPV associated is posterior mouth, good prognosis (but harder to find), white males 30-40s.
papilloma
Etiology: benign epithelial proliferation
Site: FOM, soft palate, tongue
Age: 30-50 years
Gender:
Appearance:
Frequency: sessile or penduculated, cauliflower like keratotic lesion
HPV - general info
Etiology: Low risk: VV, Condyloma Accuminatum, Hecks
High risk: oral and cervical SCC. HPV is not for life, resolves within 6mo-2yr. If persistent can transform to cancer.
Divided into alpha (mucosa, expect alpha 2&4 infect skin), Beta (mostly skin, but can infect mucosa), gamma (skin only -cutaneous)
Transmission: sex, vertical, close contact, autoinoculation.
HPV is the cause of 99.7% cervical cancers, 60-90% posterior mouth cancers (Vaccine - Gardasil 9 -up to 45yrs, males and females)
positive HPV test doesnt mean the patient will develop oral SCC
Verruca Vulgaris (common wart)
Etiology: epithelial proliferation, HPV 2/4, auto-inoculation
Age: children
Appearance: like papilloma (papillary and white), occurs in multiples
Frequency: 20% of children in the US
Condyloma acuminatum (venereal wart)
Etiology: benign papilomatous epithelial proliferation associated with HPV types 6/11. Usually sexually transmitted - if in child may indicate sexual abuse.
Site: most common in genitalia, but occurs in the mouth
Age: Any
Gender: Any
Appearance: single papillary pinkish or white lesion or as multiple membranous pink and papillomatous lesions.
Frequency: 20-30% of all STD
Focal epithelial hyperplasia
Heck’s disease!
Etiology: Infectious, HPV 13, 32
Population: Native Americans, more in South American Indian. Rare in white and black.
Site: only in the mouth! Lip and buccal mucosa are the most common locations; can also occur on the gingiva (very rare), palate and other areas.
Age: children (up to teenagers) living in poor conditions. Also rare in people 50yrs.
Gender: any
Appearance: multiple small (around 5mm or slightly larger) slightly elevated, smooth-surfaced and dome-shaped papules, pink in color, similar to the surrounding mucosa. lesions can be isolated or coalesced, forming a more diffuse and ill-defined elevation of the mucosa with cobble stone appearance. looks similar to lesions in AIDS. AIDS or other immune compromised patients can be resistant to treatment.
Intra-dermal (intra-mucosal) Nevus
Etiology: benign neoplasm/hemartomas of melanocyte origin
Site: gingiva - most common
Appearance: elevated, sometimes papillary lesion that is brown in color but may also be pink.
Frequency: 55% of oral nevi are this type! - most common
TX: ranges from nothing to conservative surgical removal
Compound Nevus
Etiology: benign neoplasm/hemartomas of melanocyte origin
Site: anywhere in oral
Appearance: brown elevated nodule
Frequency: 6% of all oral nevi
TX: ranges from no treatment to conservative surgical removal
Blue Nevus
Etiology:
Site: Palate is the most common location
Age:
Gender:
Appearance: slightly raised, bluish-black in color
Frequency: 2nd most common nevus in the oral cavity - 36% of nevi (after intra-dermal/intra-mucosal)
tx: ranges from no treatment to conservative surgical removal
Oral SCC-Tobacco
Etiology: aggressive neoplasm of epithelial origin, chronic smoking and alcohol use. 10% are non-smokers.
Site: Anterior mouth: Lateral/ventral tongue, Floor of mouth, Soft palate area/posterior mouth, Lower lip
Age: Over the age of 50; median age of 63
Gender: More common in males. M:F rate is 1.4:1 in the US and 2:1 worldwide.
population: significantly more common in black males and generally higher death rate in males but more so in black males.
Appearance: Non-healing ulcer, red or red and white lesion, ulcers with rolled borders, fungating, fixation and induration.
Frequency: 90% of all malignant neoplasms in the mouth!
HPV related oral SCC
Etiology: no/never smokers/drinkers, HPV (DAN virus) types 16, 18 are the most high risk.
Site: Posterior mouth: palatine tonsils and base of tongue
Age: Young white males under 40 years of age
Gender:
Appearance: Usually small in size, often presents at more advanced stages (lymphadenopathy of the neck). Very few clinical sign and symptoms; sometimes presenting as neck mass with no visible lesion. It can also present with dysphagia, weight loss, otalgia, tonsillar mass and less frequently with sore throat.
Frequency: its on the rise
Verrucous Carcinoma
Etiology: Non-metastasizing, low-grade, slow but persistent neoplasm of the epithelium, history of chewing tobacco, sniff dipping and smoking cigarettes. HPV 16, 18
Site: Mandibular vestibule, buccal mucosa and palate, alveolar ridge (grows into the periosteum and destroys bone), occasionally FOM
Age: 60-70yrs
Gender: males
Appearance: White, greyish-white, sometimes pink, diffuse, verrucoid. Sessile, papillary. Grows laterally rather than vertically.
TX: sx, radiation contraindicated
Basal Cell carcinoma
Etiology: sun exposure, associated with bidif rib basal cell nevus syndrome. Locally agressive neoplasm of basal cell origin.
Site: 90% occur in the upper face and forehead, oral - less than 1%
Age: middle age
Gender: white males
Appearance: smooth surfaced nodule to focal ulcer or well demarcated nodule with a central keratotic crater. the boarder is rolled and indurated.
Frequency: 80% of all skin cancers - most common cancer of the skin
TX: excision with 5mm of clearance. Can recur.
Prognosis: Rarely metastasizes/kills. If kills - bc invades the brain.
Malignant Melanoma - general
Etiology: Sunlight, family history and sunburns before age 5. Malignant neoplasm of melanocytic origin. High rate of metastasis.
Population: more common in fair haired, blue eyed
Frequency: 25% of MM occur in the skin of the head and neck. Less than 1% occur in the mouth.
Malignant Melanoma - oral
Etiology: unclear, not sun
Site: palate (most common) + maxillary mucosa = 80%, Sino nasal area
Age: 50yrs
Gender: male
Population: significant in Japanese, Blacks have more MM of oral cavity than skin.
Appearance: deeply pigmented, ulcerated and bleeding nodule. Bone involvement and exfoliation of teeth common. 70% occur within an existing benign nevus or pigmented lesion. Two growth stages - radial and vertical (bad)
Frequency: exceedingly rare, poor prognosis - worse than skin
Racial pigmentation
Dark skinned individuals, she didnt talk about it a lot
Metastasis to the mouth:
Age, symptoms, site, frequency, metastasizing organs, prognosis
Age: over 30yrs
Symptoms: Pain and swelling are the most common clinical symptoms. Anesthesia/paresthesia, especially when they involve the inferior alveolar canal resulting in so-called “numb-chin syndrome.”
Site: Posterior mandible is the most common site for metastasis followed by gingiva looking like pyogenic granuloma.
Frequency: extremely rare. Less than 1% of oral cancer cases are metastatic
metastasizing organs: breasts, lung, colon, prostate, kidney
prognosis: poor, five-year survival rate is poor
