L1: Oral Lesions Flashcards
What is Leukoplakia? Is it precancerous?
Adherent white patches/plaques on oral mucosa or tongue. Can be associated with inflammatory/autoimmune disease.
Usually benign.. HOWEVER can become SCC
Risk factors for Leukoplakia?
Tobacco and alcohol use
Diagnosis and tx for Leukoplakia?
Dx: Biopsy.
Tx: Prevent/decrease risk of oral SCC
What is Erythroplakia? Is it cancerous?
Red, velvety patch usually on mouth floor, ventral aspect of tongue, soft palate.
Very high risk of malignant transformation!!! EMERGENCY
What is Leukoerythroplakia?
White mucosal plaques with red, speckled apperance
What is oral hairy leukoplakia? Is it malignant
Vertically corrugated adherent white lesions on lateral surface of the tongue, painless. Separate from Leukoplakia… NOT premalignant!
What can cause oral hairy leukoplakia? Treatment for this?
Induced by Epstein-Barr virus and immunosuppressed individuals.
Tx: usually not indicated.
Risk factors for oral SCC?
Tobacco use, alcohol use are main factors!!
others include UV light, radiation exposure, HPV
How do oral SCC’s present?
Ulcers or masses that don’t heal!!
On tongue/lip- exophytic or ulcerative lesions, often painful.
Dysphagia, odynophagia, sore throat, hoarseness, weight loss
How to Dx and Tx Oral SCC?
Dx: Biopsy
Tx: ENT referral ( will do sx or radiation)
How does Melanoma present?
If pigmented oral lesion.. MUST consider!! remember your ABCDE’s bitches.
Painless bleeding mass, area of ulceration, region of discoloration, or w/ ill fitting dentures
Dx and Tx of Melanoma?
Dx: Endoscopic evaluation for paranasal disease, CT/MRI of primary site and CT/PET for lymph node involvement
Tx: Excision w/ clear margins or radiation therapy
What are mucoceles?
Pinkish/blue soft papule or nodules (filled w/ gelatinous fluid) lining the epithelium. May rupture.
From oral trauma!
Dx and Tx of Mucoceles?
Dx: clinical
Tx: Avoid cheek/lip biting. Can remove w/ cryotherapy/excision if symptomatic. Also CO2 laser vaporization
Most common HSV manifestation in childhood?
Herpectic gingivostomatitis (HSV-1)
Clinical presentation of oral HSV? Primary and recurrent infection.
Primary: Can be asymptomatic/symptomatic. Grouped vesicles on erythematous base, painful! Viral shedding is greatest.
Recurrent infection: Prodrom- pain/burning/tingling 6-48hrs before lesion appears fatigue, low grade fever.
How to Dx and Tx HSV?
Dx: clinical and viral culture if active lesion
Tx: Oral antiviral and supportive care (miracle mouthwash, fluids, analgesics), patient education!!
Etiology of hand foot and mouth disease? Clinical presentation?
Coxsackie A16 virus.
Painful oral lesions, spares gingiva & lips (unlike HSV)!!!
Tx of Hand foot mouth?
Supportive (hydration, analgesics).
Etiology of Oropharyngeal Candidiasis? What kind of infection is this?
Also known as Thrush.
Etiology: candida albicans
Is an opportunistic infection!
How does oropharyngeal candidiasis present?
Mouth pain. Creamy white patches, plaques with underlying erythematous mucosa. “THRUSH WILL BRUSH BABY”
Dx and Tx of oropharyngeal candidiasis?
Dx: KOH prep (if esophageal requires further investigation for underlying disease)
Tx: Topical anitfungal (nystatin) and patient education
Etiology of Erythema Multiforme Major?
HSV. Is acute, immune-mediated condition
Presentation of erythema multiform major?
Target-like lesions on skin. On mucosal erythema, painful erosions or bullae
Tx of erythema multiforme major?
Should resolve w/in 2 weeks. Symptomatic relief (topical corticosteroids, oral antihistamines, miracle mouthwash). If sever can consider systemic glucocorticoids. If ocular involvement–> refer to ophthalmology IMMEDIATELY!
How dx and treat oral SJS/TEN?
Dx: clinical
Tx: stop inciting medication, admit, supportive care
How to tx pemphigus and pemphigoid? (i’m not doing a flashcard on what they are you should already f*ckn know these)
For pemphigus- systemic corticosteroids, immunosuppressants
For phemigoid- topical and/or systemic corticosteroids, derm referral
What is the most common cause of mouth ulcers?
Aphthous Ulcers.. also known as canker sores, ulcerative stomatitis
How do aphthous ulcers present?
Shallow, round/oval, painful w/ grayish base on buccal/labial mucosa
How to tx aphthous ulcers?
Heal w/in 10-14 days. Avoid irritating food/drink. Topical steroid (triamcinolone oropharyngeal paste)
How does Behcet syndrome present?
Recurrant oral and genital ulcers. Painful, shallow or deep w/ central yellowish necrotic base.
Neurtrophilic inflammatory disorder
How to dx and tx Behcet Syndrome?
Dx: Recurrent oral ulcers (>3x/ year) AND 2 other clinical findings (ie. positive pathergy test, optic lesions, genital lesions, or cutaneous lesions)
Tx: Refer to rheumatology
What is the Pathergy test?
Nonspecific hyperactivity of the skin following minor trauma. Intradermal injection. Positive if an erythematous sterile papule develops w/in 48 hrs.
Etiology of oral lichen planus?
Chronic inflammatory disorder affecting skin and mucous membranes. May increase risk for oral cancer
Presentation of oral lichen planus?
Wickham’s striae (reticular lacy white plaques).
Can have painful erythematous red patches and erosive ulcers.
Dx and Tx of oral lichen planus?
Dx: Biopsy (ENT referral)
Tx: relief of pain, topical corticosteroids
How does Black hairy tongue present? Is it malignant?
Elongated filiform papillae, yellowish white to brown dorsal tongue.
Is benign.
Tx of Black hairy tongue?
Brush affected area of tongue w/ toothpaste BID-TID
Presentation of geographic tongue? Tx?
Erythematous patches on dorsal tongue w/ circumferential white borders.
Tx: reassurance
Presentation and tx of Atrophic Glossitis?
Appears smooth, glossy, erythematous tongue.
Tx: Address underlying condition
Etiology of atrophic Glossitis?
Inflammatory disorder leads to atrophy of filiform papillae.
Can be from nutritional def, dry mouth, celiac disease, oral candida infection, Sjrogen’s syndrome
How to use medications in the oral cavity?
- Use gel for few localized lesion.
- use rinse for widespread/ generalized erythema
- educated about possibility of oral candidiasis w/ topic immunosuppressants
- systemic therapy for more severe lesions
