Exam 3-Leukoplakia & Erythroplakia Flashcards
What is a clinicaly descriptive term for a white patch or plaque that won’t rub off and which can’t be diagnosed as any specific condition
leukoplakia
Whats the term for REVERSIBLE hyperkeratosis from a physical irritant? *It is NOT a cause of leukoplakia!! * NOT pre-malignant
Frictional Keratosis
What is the MAJORITY of leukoplakia caused by?
TOBACCO
What is the name for WHITE coloration on the PALATE of a smoker with small red macules? IS it pre-malignant? WHAT are the small red macules from?
STOMATITIS NICOTINA…..NOT pre-malignant…red from inflamed ducts
Histologically, 80% of leukoplakia can be described as one of these three….
1.hyperPARAkeratosis 2.hyperORTHOkeratosis 3.A-canth-osis
Histo: what is an increased amount of “more nucleated” keratinized cells on the surface of the epithelium?
hyperPARAkeratosis
Histo: what is an increased amount of “more mature/non nucleated” keratinized cells on the surface of the epithelium?
hyperORTHOkeratosis
Histo: what is the term for an increase in thickness of epithelium?
A-Canth-osis (latin-thorny evergreen tree lol)
ummm how much of leukoplakia will display as hyperparakaratosis/hyperorthokeratosis/acanthosis again??
80%
What % of histologic samples of leukoplakia will show EPITHELIAL DYSPLASIA (carcinoma in situ)?
17%
What % of histologic samples of leukoplakia will show superficially INVASIVE squamous cell carcinoma?
3%
What is the process the epithelium goes through prior to becoming malignant?
epithelial dysplasia (carcinoma in situ)
WHAT IS THE HISTOLOGIAL HALLMARK of epithelial dysplasia?
PleoMorphism (cells have many different shapes)
Besides the hallmark of epithelial dysplasia in a histo sample, please name 3 other important markers…
- increased/abnormal mitosis 2. increased nuclear/cytoplasmic ratios 3.hyperChromatism
Interesting….A single incisional biopsy of leukoplakia will underdiagnose ___% of the time
30%
Interesting….if we take 2 biopsies from a leukoplakia lesion our % missed diagnosis goes to ___%
12%
Interesting….if we take 3 biopsies from a leukoplakia lesion our % missed diagnosis goes to ___%
2.4%
What are the three areas of the oral cavity most at risk for leukoplakia? What are the % chance of dysplasia/invasion of each location?
1.Floor of Mouth/VENTRAL TONGUE (Freggin 50%) 2.Lateral border of the tongue (25%) 3.Lower Lip (actinic keratosis) (35%)
What is the term for when the vermilion becomes atrophic and blends with skin, variably white ± erosion ± crusting?
Actinic Keratosis (or leukoplakia of the lower lip)
NON-homogenous leukoplakia is __-__% dysplastic/invasive
50-80%
Areas of redness, ulceration, pebbly or verrucous surface describe a leukoplakia lesion that is defined as:
NON-homogeneous
What is the RARE form of PROGRESSIVE leukoplakia that is characterized by progression, multifocality, verrucous morphology, RECURRENCE after excision, progression to SCC and DEATH??
PVL-Proliferative Verrucous Leukoplakia
OVERALL: What % of leukoplakia has a chance for malignant transformation???
4-6%
OVERALL: What % of leukoplakia will transform to malignancy if DYSPLASTIC?
15%
What % of leukoplakia will transform to malignancy if NOT dysplastic?
1-3.5%
What is the recurrence rate for someone who has overcome oral cancer?
10-40%
Hmm…what is a red patch which can’t be diagnosed as a specific condition….Its a clinically descriptive term considerably LESS common than leukoplakia
erythroplakia
Where is erythroplakia most likely to show up in the oral cavity?
the high risk sites (1.FOM/VenTongue 2.LatTongue 3.LowerLip)
Histologically, what % of erythroplakia shows dysplasia/carcinoma in situ?
100% of the time…HOLY SHIT
Most early ASYMPTOMATIC oral carcinomas are ____ or ____ AND ______ lesions.
red or red AND white
How do you treat a non-dysplastic erythroplakia lesion? (like 0% of the time)
modify the risk factors and watch it (happens like 0% of the time)
If an erythroplakia lesion is considered have mild to moderate dysplasia, what is the treatment?
modify the risk factors and MAYBE or MAYBE NOT excise it
If an erythroplakia lesion is considered have severe dysplasia, what is the treatment?
modify the risk factors AND EXCISE
When we say tx for erythroplakia is modifying the risk factors….how much of it is resolved with SMOKING tobacco cessation?
50% of the time its resolved
When we say tx for erythroplakia is modifying the risk factors….how much of it is resolved with SPIT/TOPICAL tobacco cessation?
95% of the time the lesion is resolved!
He powered thru this in the lecture, not sure how important it is…premalignant conditions:
A. SIDE-RO-PENIC dysphasia B. subMucous Fibrosis C. LICHEN PLANUS (most likely NOT pre-malignant) D. Immunosupression
Which “pre-malignant” condition is CONTROVERSIAL because the risk is debatable….many cases represent MISDIAGNOSED cases of dysplasia
Lichen Planus
What are the 4 types of epithelium?
Squamous, cuboidal, pseudostratified, columnar
Which contains nuclei: ortho or parakeratin
parakaratin (ortho no nuclei)
white plaque that cannot be wiped off and cannot be characterized
clinically as any other disease
Leukoplakia