Epithelial Neoplasms Flashcards
Multifactorial disease – Two distinct pathogenesis models: • Smoking and alcohol • Human papilloma virus (HPV 16 & 18) – Actinic Radiation: Lip cancer
H+N SCC
What are the 4 most common etiological factors of oropharyngeal squamous cell carcinoma?
Smoking
Alcohol
Actinic radiation
HPV
What age group and category of person is at the highest risk for a H+N SCC?
White male 65+ smoker and drinker
• Areca nut • Betel leaf • Lime •CaOH2 • Nitrosamines Causes oral submucous fibrosis
Betel Quid
• 44M with 22 year history of use of betel nut-containing preparations • Limited oral opening, fibrous bands and leukoplakia with erosions • Premalignant condition
Oral submucous fibrosis
What is the cause of acinitic damage?
UV light
• The larger the tumor the ______ the
incidence of metastasis
higher
The occurrence of metastasis
______ survival
decreases
SCC clinical appearance:
– Mass-forming
– Fungating
– Papillary
– Verruciform
• Exophytic
SCC clinical appearance:
– Invasive
– Indurated
– Ulcerated
• Endophytic
White plaque
• Leukoplakia:
Red plaque
• Erythroplakia:
Red & white plaque
• Erythroleukoplakia:
• A white patch or plaque that can’t be characterized clinically or
pathologically as any other disease
Leukoplakia
Things making lesions white:
Increased opacity
Hyperkeratosis:
Things making lesions white:
Increased thickness
Acanthosis:
Things making lesions white:
Fibrin membrane or
fungal hyphae
Surface coating:
The following are or are not leukoplakia
• Morsicatio buccarum
• Linea alba
Not leukoplakia
What percentage of leukoplakias are dysplastic/premalignant?
20%
• A red plaque that can’t be characterized clinically or pathologically as any
other disease
Erythroplakia
What are the 2 reasons why erthroplakias are red?
Thin epithelium
Red blood cells
What percentage of erythroplakia are dysplastic or malignant?
90%
What are the 5 High Risk Areas for Premalignancy and Malignancy?
- Lower Lip
- Floor of Mouth
- Ventral Tongue
- Lateral Border of Tongue
- Soft Palate
____ or _____ is required for definitive diagnosis of oral SCC
Excisional and incisional biopsy
• Low-grade variant of squamous cell carcinoma • Locally invasive, no metastasis • Cytologically bland • Clinicopathologic correlation • Associated with smokeless tobacco
Verrucous Carcinoma
- High-risk, aggressive type of oral leukoplakia
- High potential for malignant transformation
- Not associated with tobacco use
- Women outnumber men
- Slow-growing
- Begins as hyperkeratosis
- Spreads to become multifocal and verruciform
- Resistant to therapy and recurs
- Malignant transformation
- Diagnosis often retrospective
Proliferative Verrucous Leukoplakia
What is the most common skin cancer that rarely metastasizes?
Basal cell carcinoma
What is the least common skin cancer causing the most deaths?
Malignant melanoma
• Most common skin cancer • Sun-exposed skin of adults with fair complexions • Locally invasive • Metastasis extremely rare • Arises from basal cell layer and skin appendages
Basal cell carcinoma
• Melanocytes present, no melanin produced in skin,
hair, eyes
• Enzyme defect: Tyrosinase
Oculocutaneous albinism
- No melanocytes, no melanin
* Autoimmune
Vitiligo
- Focal increase in melanin
- Normal number of melanocytes
- Lower lip vermillion most common
Oral Melanotic Macule
• Generic term for a developmental malformation of skin or musosa • Melanocytic • Epithelial • Vascular • Basal cell • White sponge • Sebaceous
Nevus
• A benign proliferation of nevus cells that develops during childhood and evolves
through clinical stages (nevus life cycle)
• Less than 6 mm
Acquired Melanocytic Nevi
• Larger than acquired nevi and involve
deeper structures
• Large congenital nevi have higher risk
for melanoma
Congenital Melanocytic Nevi
• Spindled nevus cells in connective tissue
Blue Nevus
• Malignant lesion of melanocytic origin • Acute rather than chronic sun damage • Prognosis related to depth of invasion
Melanoma
What are the ABCDs of clinical features of Melanoma?
Asymmetry
Border Irregularity
Color Variation
Diameter
What is the diameter of a melanoma?
Greater than 6 mm
What is the diameter of a melanoma?
Greater than 6 mm
_____ growth phase of melanomas
– Within the epithelium (in situ)
• Radial Growth Phase:
_____ growth phase of melanomas
– Invasion
• Vertical Growth Phase
- White adults over 50 years
- Hard palate, maxillary alveolus
- Amelanotic forms
Oral Mucosal Melanoma
• Over 130 subtypes of double-stranded, circular DNA viruses
– family of viruses that can cause abnormal tissue growth and other
changes to cells
– Can produce epithelial tumors of the skin and mucous membranes
• Infection occurs when basal cells of the epithelium are exposed to infectious
virus through a disruption in the epithelial barrier
• Once the epithelial cell is infected, viral replication is confined to the nucleus
• In oncogenic (high-risk) subtypes, oncoproteins E6 and E7 inactivate
tumor supressor genes p53 and pRB
HPV
• Solitary lesion in adult • Pedunculated, exophytic papule • Numerous surface projections • HPV-6, 11
Squamous papilloma
• Skin of hands in children • Multiple, clustered lesions common • White, verrucoid surface • Autoinoculation of oral mucosa
Verruca vulgaris
• HPV types 13 and 32 • Children • Native Americans and other ethnic groups • No treatment, spontaneous regression
Focal Epithelial Hyperplasia (Heck’s Disease)
• Venereal wart: – Sexually-transmitted disease • Multiple, clustered lesions common • Sessile, pink exophytic mass, larger than squamous papilloma • Low-risk subtypes HPV 6 and 11
Condyloma Acuminatum
- Most commonly found in children
- Infection during childbirth
- Not a sexually-transmitted disease
- HPV-6 and 11
- May cause airway obstruction
- Recur frequently
Laryngeal Papillomatosis
__% of HPV genital infections clear on their own within 2 years
90%
____% of persistent genital HPV infections will cause
dysplastic changes of the uterine cervix
will result in squamous cell carcinoma over a span of 7-10 years
5%
