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