Epithelial Pathology II Flashcards
What is the definition for a leukoplakia?
An intraoral white plaque that does not rub off and cannot be identified as any well known entity
What are 5 lesions that may appear like a leukoplakia but do rub off?
1-Materia Alba 2-White coated tongue 3-Burn (thermal, chemical, cotton roll, etc.) 4-Pseudomembranous candidiasis 5-Sloughing from toothpaste
What are 6 possible cause of a leukoplakia?
1-Tobacco 2-Alcohol (Synergistic with Tobacco) 3-Sanguinaria (Max vestibule, herbal toothpaste) 4-UV radiation (lower lip) 5-Microorganisms 6-Trauma
What 3 places are 70% of leukoplakias found?
1-Lip vermilion
2-Buccal mucosa
3-Gingiva
What 3 places are 90% of dysplastic or carcinoma leukoplakia found?
1-Lip vermilion
2-Lateral/ventral tongue
3-Floor of mouth
Red patch that cannot be diagnosed as any other condition is called what?
Erythroplakia
*True erythroplakias are never completely benign
A mixed Red and white plaque is called what?
Erythroleukoplakia
What high-risk form of leukoplakia is characterized by multiple keratotic plaques with roughened surface projections?
Proliferative verrucous leukoplakia (PVL)
*No association with tobacco use
What is the first step in arriving to a definitive diagnosis for a leukoplakia?
Biopsy
when alterations are limited to the lower 1/3 of the biopsy it is?
Mild dysplasia
When alterations are limited to the lower ½ of the biopsy it is?
Moderate dysplasia
When alterations are present above the lower ½ of the biopsy it is?
Severe dysplasia
When alterations are present throughout the epithelium it is called?
Carcinoma in situ
What are the 3 most common locations for an erythroplakia?
1-Floor of mouth
2-Ventral tongue
3-Soft palate
When the Lesion appears as a thin, gray or white plaque with a border that blends into surrounding mucosa (wavy looking texture) it is likely?
Smokeless tobacco Keratosis
*if lesions remain 6 weeks after habit is stopped, biopsy required
A chronic, progressive, scarring, high-risk precancerous condition of the oral mucosa linked to chronic placement of betel quid or paan is called?
Oral Submucous Fibrosis
*Typically in indian culture. On buccal mucosa, retromolar areas and soft palate
A white keratotic change on the palate due to heat, is not premalignant and has Punctate red centers are because of minor salivary glands is likely what?
Nicotine Stomatitis
*Reverse Smoking looks similar and is potentially malignant
What common cutaneous premalignant lesion caused by cumulative UV radiation results in scaly, irregular plaques?
Actinic Keratosis
*Usually over 40 yrs old, approx. 10% will progress to SCCA in 2 yrs
What common premalignant alteration of the lower lip vermilion results from long-term exposure to UV light?
Actinic Cheilosis
*Usually Induration (firm to the touch), Thickening (leukoplakia), and Ulceration
What syndrome is associated with iron-deficiency and has an increased risk for SCC?
Plummer-Vinson Syndrome
What are the 4 most common sites of intraoral SCC?
1-Tongue (Posterior lateral or ventral)
2-Floor of mouth
3-Soft palate
4-Gingiva
How does metastatic SCC typically spread?
Lymphatics
What are 4 descriptors for the way involved cervical lymph nodes will present?
1-Firm to stony hard
2-Painless
3-Enlarged
4-Fixed
What staging system is used as the best indicator of patient prognosis?
TNM system
*guides treatment for intraoral carcinoma
Which letter of the TNM system represents the size of primary local tumor in centimeters?
T
Which letter of the TNM system represents Involvement of local lymph nodes?
N
Which letter of the TNM system represents Distant metastasis?
M
What system uses histologic features to classify tumors?
Grading
AKA Snuff Dipper’s cancer what low-grade variant of oral SCC can be caused by smokeless tobacco and appears as a cauliflower-like mass?
Verrucous Carcinoma
*Surgical excision w/o neck dissection, 90% disease free
Malignancies that arise from the lining epithelium of the nasopharynx and are associated with EBV infection and consumption of N-nitrosamines (salty fish) are called?
Nasopharyngeal Carcinoma
*Most prevalent in chinese men. First sign in half of patients is cervical lymph node metastasis
Which cancer is the most common of all cancers, locally invasive and slow spreading and result from UV radiation?
Basal Cell Carcinoma
What is the most common form of Basal Cell Carcinoma?
Nodular (noduloulcerative)
*telangiectatic blood vessels usually seen
What surgery depends on the size and location of the basal cell carcinoma and involves progressively scooping out lesion and freezing sections for analysis?
Mohs Micrographic surgery
Which lesion is a Malignant neoplasm of melanocytic origin or which acute UV radiation is a major causative factor?
Melanoma
*3rd most common skin cancer, but accounts for the most deaths
What are the two directional patterns of growth for Melanomas?
1-Radical (Horizontal spread, flat lesion)
2-Vertical (invade underlying CT)
What are the components of the ABCDE system to describe clinical features of melanoma?
1-Asymmetry 2-Border irregularity 3-Color variation 4-Diameter greater than 6 mm (roughly the end of an eraser) 5-Evolving lesions
What system is used to classify the depth of invasion as it correlates with prognosis of melanoma?
Clark’s Classification for cutaneous melanoma
What are 3 key points about determining prognosis for melanoma?
1-Ulceration is an adverse prognostic indicator for cutaneous melanomas
2-Ulceration has not been proven to be a prognostic indicator in mucosal melanomas
3-Any invasion more than 0.5 mm in oral mucosal melanoma has poor prognosis
What are the 4 areas with the worst prognosis for melanoma? BANS
1-Back (Interscapular area of the)
2-Arm (Posterior upper)
3-Neck(Posterior & lateral)
4-Scalp
