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Epithelial Neoplasms Flashcards

1
Q

This epithelial neoplasm is more common in white, blue-collar males ranging from 10-30 years old, or an average age of 18.

A

Smokeless Tobacco/Snuff Dipper’s Keratosis

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2
Q

What is the clinical presentation of smokeless tobacco keratosis?

A

1) well-demarcated translucent grayish
2) white/yellow rough and wrinkled with deep furrows
3) Severity depends on time of exposure

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3
Q

True or False:

Smokeless Tobacco has a high potential for malignant transformation

A

FALSE

Smokeless Tobacco has a LOW potential for malignant transformation

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4
Q

What patients have a 50-fold increase for developing carcinoma of the buccal mucosa or gingiva?

A

Smokeless tobacco patients

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5
Q

How long will it take for smokeless tobacco keratosis lesions to regress?

A

2-6 weeks

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6
Q

How would you treat smokeless tobacco keratosis?

A

If in a high risk location, complete excision
To biopsy, excise the worst looking areas
Mandatory long-term followup

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7
Q

What is the clinical presentation of smoking-related keratosis?

A

Benign: hyperkeratosis, acanthosis, melanin incontinence
Malignant: epithelial dysplasia, carcinoma in situ, invasive SCC

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8
Q

Papillomas are associated with what type of HPV?

A

HPV 6 and 11

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9
Q

Verruca Vulgaris is associated with what type of HPV?

A

HPV 2 and 4

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10
Q

What population does verruca vulgaris affect?

A

Children

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11
Q

True or False:

Verruca vulgaris and Papillomas both occur in multiples.

A

FALSE
VV: multiples
Papilloma: single lesion unless associated with a syndrome

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12
Q

What is the histopatholgy of VV?

A

1) Thick keratin layers
2) Alternating para and orthokeratin
3) Granular cell layer and keratohyaline granules

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13
Q

What is condyloma acuminatum?

A

Venereal wart

Papillomatous proliferation of surface epithelium

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14
Q

What HPV type is condyloma acuminatum associated with?

A

HPV 6 and 11

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15
Q

What is the clinical presentation of condyloma acuminatum?

A

Single white-pink lesions or multiple pink papillomatous lesions

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16
Q

What is the etiology of condyloma acuminatum?

A

STDs

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17
Q

What is the treatment for condyloma acuminatum?

A

Chemical cauterizaiton
Surgical removal
Need to treat both partners or else risk of re-inoculation

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18
Q

What population is affected by focal epithelial hyperplasia?s

A

RARE in age 50, white and black
Common in Native america and South American indian population

age

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19
Q

What sites are affected by Heck’s Disease?

A

Almost always oral cavity

Lip and buccal mucosa most common, but can happen on gingiva, palate

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20
Q

What are the clinical features of Heck’s disease?

A

Multiple, smooth-surfaced lesions 5mm+ usually the same color as surrounding mucosa

Can be isolated or coalesced to form more diffuse, ill-defined elevations

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21
Q

What HPV type is focal epithelial hyperplasia associated with?

A

HPV type 13 and 32

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22
Q

What is the treatment of Heck’s disease?

A

Usually disappears by teenage years
Liquid nitrogen, laser treatment, intralesional injections, topical chemotherapy

Infective on contact, need to advise patient - no sharing food/drink

Recurrence rare once disappeared/treated unless AIDS pt

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23
Q

List the 4 types of pigmented nevi in order of most to least prevalent in the oral cavity.

A
  1. Intramucosal
  2. Blue nevus
  3. Compound
  4. Junctional
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24
Q

What are the clinical features of the pigmented nevi?

A
  1. Intramucosal - elevated/papillary brown or pink lesion, gingiva is most common
  2. Blue nevus - flat but not as flat as junctional, blue-black, palate is most common
  3. Compound - elevated nodule anywhere in the oral cavity
  4. Junctional - flat, well demarcated, brow
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25
How do you treat pigmented nevi in the oral cavity?
Surgical excision due to constant exposure to masticatory friction
26
What is the most common malignant neoplasm of the mouth?
Oral squamous cell carcinoma
27
What populations are affected by oral SCC?
men over 55-60 or young adults with long history of smokeless tobacco use
28
What are the clinical features of oral SCC?
Characteristic signs are white, red and white, predominantly red, non-healing ulceration, ulcers with rolled borders, fungation (necrosis), fixation and induration At early stages, the SCC lesions are usually asymptomatic. Painful SCC lesions represent advanced disease.
29
What histopathological factor is required for the diagnosis of SCC?
Invasion of the basement membrane into the connective tissue
30
Who are commonly affected by spindle cell carcinoma?
Adult males, avg 57
31
What are the most common sites for spindle cell carcinoma?
Lower lip Tongue Alveolar ridge
32
What are the clinical features of HPV-associated SCC?
HPV-induced cancer is usually small in size, often presents at a more advanced stage of the disease with an unexplained, non-tender lymphadenopathy in the neck. The lymph nodes are usually very large and cystic. It can also present with dysphagia, odynophagia, weight loss, otalgia, tonsillar mass and less frequently with sore throat.
33
What is solar keratosis?
SCC of the lip due to too much sun
34
Who is affected by solar keratosis?
Fair skinned population
35
What is the most common cause of lip pre-malignant and malignant lesions?
Solar keratosis
36
What are the clinical features of solar keratosis?
Atrophic, pale, gray and glossy lips. Possible fissuring. No line between vermillion border and skin.
37
How is solar keratosis treated?
Complete surgical removal
38
Where does solar keratosis commonly occur?
Lower lips, especially vermillion border
39
Where do 90% of oral SCC occur in pipe and cigar smokers?
Lower lips, especially vermillion border
40
What is the prognosis of oral SCC found on the lip?
GOOD 80-90% 5-year survival rate | Only 5-10% metastasize if treated early
41
25-50% of oral SCC is found where?
Tongue
42
Ventral and lateral carcinomas are more common in who?
Males age 60+ with alcohol and/or tobacco use
43
What is the prognosis of oral SCC found on the tongue?
POOR | 5 year survival below 35%, depending on size and metastases of the tumor
44
Oral SCC in the floor of the mouth accounts for what percent of all oral carcinomas?
17%
45
A patient presents with an red, indurated ulcer on one side of the midline on the anterior floor of the mouth. What is the most likely diagnosis?
Oral SCC of the floor of the mouth
46
What is the prognosis if SCC is found on the floor of the mouth?
POOR with metastasis | Fair if diagnosed early (65% 5ysr)
47
How would you treat a patient with oral SCC on the floor of the mouth?
Surgery and radiation | Radiation and chemo alone only in terminal cases
48
What is the most uncommon location for oral SCC?
Buccal mucosa, 3%
49
What is the 5ys of oral SCC of the buccal mucosa?
28-50%
50
Treatment of oral SCC of the buccal mucosa requires what?
surgery and radiation
51
What is the etiology of oral SCC in the buccal mucosa?
Chewing tobacco and betel
52
SCC of the gingiva accounts for what % of all oral carcinomas?
10-12%
53
What presents as a non-healing ulcer or exophytic verrucoid lesion with bone invasion in 50% of cases?
SCC of the gingiva and alveolar mucosa
54
True or False: | The mandibular gingiva is more affected in oral scc of the gingiva and alveolar mucosa
TRUE
55
SCC of the palate accounts for what % of all oral carcinomas?
9%
56
True or false: | SCC of the palate affects the HARD palate more often than soft.
FALSE | SCC of the palate affects the SOFT palate,
57
How does scc of the palate normally present?
Painful ulcer on one side of the midline often on the soft palate
58
How do you treat oral scc?
1) surgery 2) radiation for lesions less than 3mm and not next to bone 3) surgery + radiation in advanced cases 4) chemo reduces size but not survival
59
How does prognosis of oral SCC differ in regards to anterior/posterior location?
The more posterior, the worse prognosis
60
Verrucous carcinoma affects which population?
Males age 60-70
61
What are possible etiologies for verrucous carcinoma?
Chewing tobacco, heavy cigarette smoking, HPV 16/18
62
How does verrucous carcinoma present?
Slow growing low-grade malignancy non-metastasizing, only superficially invasive (lateral growth only) Sessile Papillary Gray-white Can destroy underlying bone if on periosteum
63
What sites are affect by verrucous carcinoma?
buccal mucosa, gingiva, alveolar ridge | Sometimes palate and floor of mouth
64
Histological examination yields hyperkeratosis and keratin plugging, with bulbous rete pegs but little mitosis and inflammation. What is this?
Verrucous carcinoma
65
Who is affected by PVL?
80% are females age 60+ | Proliferative verrucous leukoplakia
66
True or false | Verrucous carcinoma is treated with surgery and radiation
FALSE | Surgery only, NO radiation because it can lead to invasive chages
67
What is the ABCDE rule of pigmented lesions?
``` A: asymmetry B: border (irregular) C: color (not uniform) D: diameter more than 6mm E: enlarging ``` Also bleeding and ulceration
68
The Japanese and African Americans are commonly affected by what?
Malignant melanoma of the oral cavity
69
What are the clinical features of malignant melanoma?
Deeply pigment, ulcerated and bleeding nodule 70% of cases were in previously pigmented lesions Can also involve bone and teeth exfoliation
70
What sites are most affected by malignant melanoma?
Palate and maxillary mucosa
71
What are the two histological phases of malignant melanoma?
Radial and vertical growth
72
How does prognosis differ between the two growth phases of malignant melanoma?
Radial growth: good | Vertical growth: bad because MM invades the basement membrane
73
What are the 4 classifications of malignant melanoma?
1. lentigo maligna melanoma 2. acral letignous melanoma 3. superficial spreading melanoma 4. nodular melanoma
74
True or False | All 4 classifications of malignant melanoma go through the 2 stages of radial and vertical growth
FALSE | Nodular is VERTICAL growth ONLY
75
Which has a worse prognosis: melanoma of the skin or oral cavity?
Oral cavity is worse | Hard to treat surgically, usually discovered late
76
How common is tumor metastases to the oral cavity?
RARE, 1%
77
What are the most common malignant neoplasms to metastasize to the oral cavity?
``` Breast Lung Kidney Colon Prostate ```
78
Where is the most common location for tumor metastases to the oral cavity found?
Posterior mandible, then gingiva
79
What are common symptoms of tumor metastases to the mouth?
Pain and anesthesia - Numb chin syndrome because if IA nerve involvement

Oral Pathology (2 decks)

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