Exam 1 Flashcards
1
Q
White patch that CANNOT be scraped off and cannot be diagnosed as any other condition:
A
Leukoplakia
2
Q
What is just a clinical term that needs biopsy if persistent
A
Leukoplakia
3
Q
Is leukoplakia premalignant?
A
YES!
4
Q
Does cheek chewing cause leukoplakia?
A
NO! leukoplakia is only if it’s NOT diagnosed as something else
5
Q
If cheek is white and you stretch it and it disappears, it is:
A
Leukoedema
6
Q
Is smokeless tobacco kertosis premalignant?
A
NO!
7
Q
Does candidiasis rub off?
Lichen planus?
Which one is bilateral?
A
Yes
- No
- Lichen
8
Q
Leukoplakia is prevalent in:
- Caused by:
- Most affected site:
A
Older males >40
- Cigarettes and UV exposure
- Gingiva
9
Q
Highest risk sites for dysplasia from leukoplakia
A
Tongue, floor of mouth, lip vermillion
10
Q
Sharply demarcated (well defined) white plaque (hyperkeratosis) with variable surface
A
Leukoplakia
11
Q
Which leukoplakia is worse, homogenous or heterogenous?
A
Heterogenous has higher risk
12
Q
What is leukoplakia with red in it?
A
Erythroleukoplakia (speckled leukoplakia)
13
Q
Which is more serious…leukoplakia or erythroplakia?
-Which is more common?
A
Erythroplakia is worse
-Leukoplakia is more common
14
Q
Velvety red, well defined pathc usually on latral tongue, floor of mouth, or soft palate
A
Erythroplakia
15
Q
Microscopically, 90% of these lesions are severe epithelial dysplasia or worse at time of biopsy
A
Erythroplakia
16
Q
In erythroplakia, the red appearance is due to:
A
lack of keratin production on the surface of the lesion
17
Q
What is a premalignant sun-induced skin lesion caused by chronic UV exposure?
A
Actinic (solar) Keratosis
18
Q
Is Actinic Keratosis more common in upper or lower lip?
A
Lower
19
Q
What is a scaly plaque with reddish base and sandpaper texture?
A
Actinic (solar) keratosis
20
Q
What color is Actinic Keratosis
A
Red and White
21
Q
Actinic Keratosis gives rise to:
A
Squamous Cell Carcinoma (SCC)
22
Q
Actinic Keratosis treatment
A
Topical liquid nitrogen, surgical excision, laser ablation, 5-FU, or imiquimod (aldara)
23
Q
What is the term for Actinic Keratosis of the lower lip?
A
Actinic Cheilosis (cheilitis)
24
Q
Actinic Cheilosis treatment
A
Vermilionectomy or laser ablation. 5-FU and imiquimod in select cases
25
What is the most common skin cancer?
| -How many cases diagnosed per year?
Basal Cell Carcinoma
| -3 mil cases diagnosed per year
26
What usually develops in middle third of face?
Basal Cell Carcinoma
27
Nodulo-ulcerative (large lobules of tumor cells are characterisitic) type is the most common clinical presentation of:
Basal Cell Carcinoma
28
Umbilicated pearly papule that may show central ulceration describes:
Basal Cell Carcinoma
29
Why are Basal Cells pigmented?
Activation of benign melanocytes
30
What is the most aggressive (least common) form of Basal Cell
Sclerosing (morpheaform)
31
What resembles a scar due to induction of collagen formation by tumor cells?
Sclerosing form of Basal Cell
32
Is it easy to assess borders clinically of Sclerosing form of Basal Cell?
NO! because of infiltrative growth pattern
33
Tx of basal cell
Scalpel excision, electrocautery and curettage, cryotherapy, Topical agents (5-FU, imiquimod), Mohs micrographic surgery
34
Basal cell has a ____ prognosis with __% of patients cured after first treatment
Great
| 95%
35
Which Basal cells warrant Mohs Surgery
Larger lesions, reccurent lesions, tumors in areas of embryonic fusion
36
Most common ORAL malignancy
Squamous Cell Carcinoma
37
Squamous Cell a lot of times arises from:
Actinic Keratosis
38
Common sites for Squamous Cell Carcinoma
Face, helix of ear, dorsum of hands, and arms
39
Squamous Cell Carcinoma tx:
Surgical excision
40
How fast does actinically-induced SCC grow?
| Are they differentiated?
Slow
| Well-differentiated
41
SCC prognosis
Good if lesion is identified early in course
42
Oral SCC is usually associated with
cigarette smoking
43
When oral SCC is seen in younger (
Tongue
44
Oral Squamous Cell Carcinoma appearance:
Irregular shape, mixture of red and white
- Often ulcerated
- Exophytic (growing out) or endophytic (growing in) growth pattern
- Often much FIRMER than surrounding tissues
45
Symptoms of oral SCC
Early=Asymptomatic. Pain is late feature
46
Ragged radiolucency ("moth eaten") is characteristic of _____ that involves underlying bone
SCC
47
What site is uncommon for oral SCC but is more common in WOMEN
Gingiva/Alveolar mucosa
48
Most SCC's affecting the palate arise on the:
lateral soft palate
49
Oral SCC tx:
Wide surgical excision and/or radiation therapy
50
Oral SCC prognosis:
| Where can it spread to?
```
Very Poor (60% survival) cuz most patients present in stage III or IV
-Regional lymph nodes
```
51
Around 25% of ____ patients will develop new upper _____ malignancies
SCC
| Aerodigestive tract malignancies
52
What is the less aggressive and uncommon form of SCC
Verrucous Carcinoma
53
Most common areas of Verrucous Carcinoma
Alveolar mucosa, buccal mucosa, and hard palate
54
What lesion is diffues mix of red and white plaque that grows laterally
Verrucous Carcinoma
55
What therapy should NOT be used on Verrucous Carcinoma
Radiation cuz it transform into more aggressive SCC
56
Approximately __% of verrucous carcinomas, upon complete excision, show transformation to SCC
25%
57
Most common location of Mucocele? __%?
Lower lip (75%)
58
What is a non-tender, soft swelling, translucent to bluish lesion?
Mucocele
59
Most common location of Sialolithiasis
Submandibular gland
60
When do symptoms show from Sialolithiasis?
DURING meals
61
What is Acute Sialadentitis?
| -It is a _____ infection (associated with ____ , may follow _____)
Bacterial, often penicillinase producing staph
| -Retrograde infection...xerostomia...general anesthesia)
62
UNILATERAL swelling, PAINFUL and tender, PURULENT exudate expressed from parotid papilla describes:
Acute Sialadenitis
63
Chronic Sialadenitis is often associated with:
Sialothiasis
64
What shows "sausage link" appearance of ductal system?
Chronic Sialadenitis
65
Tx for Chronic Sialadenitis
Tetracycline
66
Xerostomia is usually associated with
Glandular hypofunction
67
Types of medications that cause xerostomia
Antihistamines, antidepressants, sedatives/anxiolytics, hypertensive agents
68
What are Sialogogues
Substance that increases salivary flow (like lemon drops)
69
Benign Lymphoepithelial Lesion (BLEL) alone may represent an isolated form of _____ or it may be associated with it
Sjogren's Syndrome
70
Recent data suggests that a portion of the infiltrate from Benign Lymphoepithelial Lesion (BLEL) is monoclonal perhanps representing a low grade ____ in situ
Lymphoma
71
Benign Lymphoepithelial Lesion (BLEL) is more predominant in:
females
72
Benign Lymphoepithelial Lesion (BLEL) presents as:
unilateral or bilateral, firm, non-tender swelling of the parotid area
73
On the sialography, what shows a "blossoms on a tree" pattern of punctate sialectasis
Benign Lymphoepithelial Lesion (BLEL)
74
What causes destruction of the normal parotid parenchyma with replacement by a diffuse lymphocytic infiltrate?
Benign Lymphoepithelial Lesion (BLEL)
75
In Benign Lymphoepithelial Lesion (BLEL) you must identify ____which probably represent residual duct structures
Epimyoepithelial Islands (which can be seen in lymphoma too)
76
Benign Lymphoepithelial Lesion (BLEL) tx:
Varies from doing nothing to low-dose radiation or corticosteroid therapy
77
BLEL prognosis
Good
78
Sjogren's Syndrome may be thought of as a continuation of:
BLEL
79
Difference of Primary and Secondary Sjogren's Sydnrome
Secondary includes an autoimmune disorder
80
Sjogren's syndrome has a marked _____ predilection with a __:__ ratio
Female 8:1
81
What is the Schirmer test?
Strip to measure tears (lacrimal function)
82
How many minor salivary glands need to be removed in Labial Salivary Gland Biopsy?
5
83
Histology of Sjogren's Syndrome:
| -What does it differ from?
Lymphocytic Sialaenitis withOUT fibrosis
| -Differs from non-specific chronic sclerosing sialadenitis
84
Pts with Sjogren's Syndrome tend to have elevated _____ rate, elevated levels of ___ and _____
Sedimedntation
ANA
Hypergammaglobulinemia
85
Pts with Sjogren's Sydrome have a __-__x increase in ______
20-44 TIMES
| Lymphoma
86
What general age group is Necrotizing Sialometaplasia more common in?
Adults
87
Most common location of Necrotizing Sialometaplasia
Posterior hard palate/anterior soft palate
88
How long after swelling does the piece of palate fall out from Necrotizing Sialometaplasia?
-How long does it take to heal once it falls out?
2 weeks
| -4-6weeks
89
Necrotizing Sialometaplasia is easily mistaken for _______ or _____
-How can you easily tell that Necrotizing Sialometaplasia isn't cancer?
Mucoepidermoid Carcinoma or Squamous Cell Carcinoma
| -It has sharp borders unlike cancer
90
Necrotizing Sialometaplasia shows ________ with squamous metaplasia of the ______ epithelium
PEH (PseudoEpitheliomatous Hyperplasia)
| -Ductal
91
Dermatologic term for freckles
Ephildes
92
What are Actinic Lenigines?
| -Diff from freckles bc:
Sun spots on hands (age/liver spots)
| -These don't wax and wane with sun
93
What is a common, harmless tan lesion on the lip or intraorally that has NO change with sun exposure
Melanotic Macule
94
Tx for an intraoral Malanotic Macule
Excision to rule out early melanoma
95
What has an average of 20/person in caucasians?
Acquired Melanocytic Nevus
96
_____ nevi are the first stage of Acquired Melanocytic Nevus. They appear ___ and are usually ____ in color
Junctional
| -Flat, dark
97
A _____ nevus may evolve into a ____ nevus as patient gets older
Junctional --> Compound
98
With time, nevus cells may proliferate to the extent that they are completely contained within the _________
Dermal Connective Tissue (hence "Intradermal Nevus")
99
Chance of nevus transformation into melanoma is:
1 in a million
100
Congenital Melanocytic Nevus is present in __% of newborns
1%
101
For Congential Maloncytic Nevus risk of malignant transformation is __% for small and __% for large
1% for small
| 15% for large
102
Blue Nevus appears blue due to:
Depth of the melanin pigment (Tyndall effect)
103
Blue Nevus usually appears in what decade of life?
Fourth (30's)
104
Blue Nevus microscopically shows a collection of _______ within the connective tissue
Dendritic Melanocytes
105
If you had blistering sunburn early in life, you have increased risk of:
Melanoma
106
Melanoma has a diameter greater than __mm
6mm
107
What is Melanoma in a purely radial growth phase called?
Lentigo Maligna
108
Large macular lesion with IRREGULAR borders and UNEVEN pigmentation on FACIAL skin affecting an older person with fair complexion =
Lentigo Maligna
109
__% of melanomas arise in Lentigo Maligna
5
110
__% of melanomas are Superficial Spreading Melanoma
70%
111
Superficial Spreading Melanomas are usually found in ______ are of men, and ____of women.
-__% of Superficial Spreading are found in the head and neck region
Interscapular area of men
Legs of women
-20%
112
__% of melanomas are Nodular Melanoma.
- They appear as:
- __% appear in the head and neck region
15%
- Rapidly growing nodule
- 33% (1/3)
113
Nodular Melanoma may be ___ (don't produce melanin and resemble pyogenic granuloma)
Ameloanotic
114
__% of melanomas are:
Acral Lentiginous Melanoma
115
Which melanoma affects palms, soles, and oral mucosa/
Acral Lentiginous Melanoma
116
What is the most common clinical type of melanoma in persons of color?
Acral Lentiginous Melanoma
117
Melanoma prognosis depends on:
Depth of invasion
118
__% of Basal Cell Carcinoma arise in head and neck
80%
119
Oral Squamous Cell Carcinoma is associated with cigarette smoking __% of the time
80%
120
Leukoplakia perecentages..
- __% of non-dysplastic lesions will transform if not treated
- __% of dysplastic lesions will transform
- __% of leukoplakis will recur
15
33
30
