Epithelial Neoplasms Flashcards
This epithelial neoplasm is more common in white, blue-collar males ranging from 10-30 years old, or an average age of 18.
Smokeless Tobacco/Snuff Dipper’s Keratosis
What is the clinical presentation of smokeless tobacco keratosis?
1) well-demarcated translucent grayish
2) white/yellow rough and wrinkled with deep furrows
3) Severity depends on time of exposure
True or False:
Smokeless Tobacco has a high potential for malignant transformation
FALSE
Smokeless Tobacco has a LOW potential for malignant transformation
What patients have a 50-fold increase for developing carcinoma of the buccal mucosa or gingiva?
Smokeless tobacco patients
How long will it take for smokeless tobacco keratosis lesions to regress?
2-6 weeks
How would you treat smokeless tobacco keratosis?
If in a high risk location, complete excision
To biopsy, excise the worst looking areas
Mandatory long-term followup
What is the clinical presentation of smoking-related keratosis?
Benign: hyperkeratosis, acanthosis, melanin incontinence
Malignant: epithelial dysplasia, carcinoma in situ, invasive SCC
Papillomas are associated with what type of HPV?
HPV 6 and 11
Verruca Vulgaris is associated with what type of HPV?
HPV 2 and 4
What population does verruca vulgaris affect?
Children
True or False:
Verruca vulgaris and Papillomas both occur in multiples.
FALSE
VV: multiples
Papilloma: single lesion unless associated with a syndrome
What is the histopatholgy of VV?
1) Thick keratin layers
2) Alternating para and orthokeratin
3) Granular cell layer and keratohyaline granules
What is condyloma acuminatum?
Venereal wart
Papillomatous proliferation of surface epithelium
What HPV type is condyloma acuminatum associated with?
HPV 6 and 11
What is the clinical presentation of condyloma acuminatum?
Single white-pink lesions or multiple pink papillomatous lesions
What is the etiology of condyloma acuminatum?
STDs
What is the treatment for condyloma acuminatum?
Chemical cauterizaiton
Surgical removal
Need to treat both partners or else risk of re-inoculation
What population is affected by focal epithelial hyperplasia?s
RARE in age 50, white and black
Common in Native america and South American indian population
age
What sites are affected by Heck’s Disease?
Almost always oral cavity
Lip and buccal mucosa most common, but can happen on gingiva, palate
What are the clinical features of Heck’s disease?
Multiple, smooth-surfaced lesions 5mm+ usually the same color as surrounding mucosa
Can be isolated or coalesced to form more diffuse, ill-defined elevations
What HPV type is focal epithelial hyperplasia associated with?
HPV type 13 and 32
What is the treatment of Heck’s disease?
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
List the 4 types of pigmented nevi in order of most to least prevalent in the oral cavity.
- Intramucosal
- Blue nevus
- Compound
- Junctional
What are the clinical features of the pigmented nevi?
- Intramucosal - elevated/papillary brown or pink lesion, gingiva is most common
- Blue nevus - flat but not as flat as junctional, blue-black, palate is most common
- Compound - elevated nodule anywhere in the oral cavity
- Junctional - flat, well demarcated, brow
How do you treat pigmented nevi in the oral cavity?
Surgical excision due to constant exposure to masticatory friction
What is the most common malignant neoplasm of the mouth?
Oral squamous cell carcinoma
What populations are affected by oral SCC?
men over 55-60 or young adults with long history of smokeless tobacco use
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.
What histopathological factor is required for the diagnosis of SCC?
Invasion of the basement membrane into the connective tissue
Who are commonly affected by spindle cell carcinoma?
Adult males, avg 57
What are the most common sites for spindle cell carcinoma?
Lower lip
Tongue
Alveolar ridge
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.
What is solar keratosis?
SCC of the lip due to too much sun
Who is affected by solar keratosis?
Fair skinned population
What is the most common cause of lip pre-malignant and malignant lesions?
Solar keratosis
What are the clinical features of solar keratosis?
Atrophic, pale, gray and glossy lips. Possible fissuring. No line between vermillion border and skin.
How is solar keratosis treated?
Complete surgical removal
Where does solar keratosis commonly occur?
Lower lips, especially vermillion border
Where do 90% of oral SCC occur in pipe and cigar smokers?
Lower lips, especially vermillion border
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
25-50% of oral SCC is found where?
Tongue
Ventral and lateral carcinomas are more common in who?
Males age 60+ with alcohol and/or tobacco use
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
Oral SCC in the floor of the mouth accounts for what percent of all oral carcinomas?
17%
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
What is the prognosis if SCC is found on the floor of the mouth?
POOR with metastasis
Fair if diagnosed early (65% 5ysr)
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
What is the most uncommon location for oral SCC?
Buccal mucosa, 3%
What is the 5ys of oral SCC of the buccal mucosa?
28-50%
Treatment of oral SCC of the buccal mucosa requires what?
surgery and radiation
What is the etiology of oral SCC in the buccal mucosa?
Chewing tobacco and betel
SCC of the gingiva accounts for what % of all oral carcinomas?
10-12%
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
True or False:
The mandibular gingiva is more affected in oral scc of the gingiva and alveolar mucosa
TRUE
SCC of the palate accounts for what % of all oral carcinomas?
9%
True or false:
SCC of the palate affects the HARD palate more often than soft.
FALSE
SCC of the palate affects the SOFT palate,
How does scc of the palate normally present?
Painful ulcer on one side of the midline often on the soft palate
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
How does prognosis of oral SCC differ in regards to anterior/posterior location?
The more posterior, the worse prognosis
Verrucous carcinoma affects which population?
Males age 60-70
What are possible etiologies for verrucous carcinoma?
Chewing tobacco, heavy cigarette smoking, HPV 16/18
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
What sites are affect by verrucous carcinoma?
buccal mucosa, gingiva, alveolar ridge
Sometimes palate and floor of mouth
Histological examination yields hyperkeratosis and keratin plugging, with bulbous rete pegs but little mitosis and inflammation. What is this?
Verrucous carcinoma
Who is affected by PVL?
80% are females age 60+
Proliferative verrucous leukoplakia
True or false
Verrucous carcinoma is treated with surgery and radiation
FALSE
Surgery only, NO radiation because it can lead to invasive chages
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
The Japanese and African Americans are commonly affected by what?
Malignant melanoma of the oral cavity
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
What sites are most affected by malignant melanoma?
Palate and maxillary mucosa
What are the two histological phases of malignant melanoma?
Radial and vertical growth
How does prognosis differ between the two growth phases of malignant melanoma?
Radial growth: good
Vertical growth: bad because MM invades the basement membrane
What are the 4 classifications of malignant melanoma?
- lentigo maligna melanoma
- acral letignous melanoma
- superficial spreading melanoma
- nodular melanoma
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
Which has a worse prognosis: melanoma of the skin or oral cavity?
Oral cavity is worse
Hard to treat surgically, usually discovered late
How common is tumor metastases to the oral cavity?
RARE, 1%
What are the most common malignant neoplasms to metastasize to the oral cavity?
Breast Lung Kidney Colon Prostate
Where is the most common location for tumor metastases to the oral cavity found?
Posterior mandible, then gingiva
What are common symptoms of tumor metastases to the mouth?
Pain and anesthesia - Numb chin syndrome because if IA nerve involvement