Leukoplakia? (First lecture)

Question 1

white patch of the oral mucosa that cannot be scraped off and connot be dx clinically or microscopically as any other condition

Answer 1

leukoplakia

Question 2

Is leukoplakia a clinical term?

Answer 2

yes, so it is not a dx

Question 3

is leukoplakia malignant?

Answer 3

no, it is premalignant

Question 4

who is at risk of getting leukoplakia?

Answer 4

older adult males (greater than 50)

-ppl that smoke cigs

Question 5

what are the clinical signs of leukoplakia?

Answer 5

• sharply demarcated white plaque with smooth, verrucous or micronodular surface
• if red component is present - “speckled leukoplakia”

Question 6

what are the common sites for leukoplakia?

Answer 6

-ventral tongue, FOM, tonsillar pillars

Question 7

a potent antibiotic that caused leukoplakia?

Answer 7

sanguinaria-associated leukoplakia

-occurs when pts use Viadent toothpaste or mouthwash

Question 8

where does anguinaria - associated leukoplakia usually affect?

Answer 8

max buccal gingiva and vestibule

Question 9

what is seen histopathologically with sanguinaria - associated leukoplakia?

Answer 9

epithelial atypia or mild dysplasia

Question 10

what is seen histopathologically for all types of leukoplakia?

Answer 10

• some degree of hyperkeratosis (wet keratin appears white)
• often sharpley demarcated from normal epi
• precancerous changes may be evident microscopicallly (epitherlial dysplasia)
• mild, moderate, severe dysplasia or carcinoma-in-situ

Question 11

what is the tx for leukoplakia?

Answer 11

• controversial
• for no dyplasia/mild = watch and wait
• for moderate dyplasia = remove by the most convienient means available

Question 12

what is the px of leukoplakia?

Answer 12

• GUARDED
• 15% of non-dyplastic lesions will transform if not tx
• 33% of dysplasic lesions will transform
• 30% of leukoplakias will recur

Question 13

a red patch that cannot be dx as an other condition clinically or microscopically

Answer 13

erythroplakia

Question 14

is erythroplakia or leukoplakia more serious?

Answer 14

erythroplakia

Question 15

what are the clinical signs of erythroplakia?

Answer 15

velvety-red, well-demarcated patch, usually affecting the lateral tongue, FOM, or soft palate

Question 16

microscopically, what does erythroplakia look like?

Answer 16

90% of these lesions are severe epi dysplasia or worse at the time of biopsy

Question 17

why does erythroplakia appear red?

Answer 17

lack of keratin production on the surface of the lesion

Question 18

which is more advance when initially detected, leukoplakia or erythroplakia?

Answer 18

erythroplakia

Question 19

what is the tx and px of erythroplakia?

Answer 19

same as leukoplakia if it has a similar degree of epithelial dysplasia

Question 20

premalignant sun-induced skin lesion

Answer 20

actinic keratosis

Question 21

where are the common sites for actinic keratosis?

Answer 21

• facial skin

- vermillion zone of the lips in fair-skinned persons over 40 years of age

Question 22

what causes actinic keratosis?

Answer 22

ultraviolet light exposure

Question 23

what is the clinical appearance of actinic keratosis?

Answer 23

scaly plaque with sandpaper texture

Question 24

what are the histological findings of actinic keratosis?

Answer 24

• hyperkeratosis, usually perakeratin

- some degree of epi dysplasia or even superficially invasive squamous cell carcinoma in situ

Question 25

what is the tx for actinic keratosis of the skin?

Answer 25

• topical liquid nitrogen
• surgical excision
• laser ablation
• effudex
• aldara

Question 26

what is the px for actinic keratosis?

Answer 26

fair - good

-pts must be monitored for development of new lesions though

Question 27

term for actinic keratosis involving the vermillion zone of the lower lip

Answer 27

actinic cheilosis (cheilitis)

Question 28

what are the clinical signs of actinic cheilosis?

Answer 28

chronic scaling, crusting, ulceration and/or fissuring of the lip may be seen

Question 29

what is the tx of actinic cheilosis?

Answer 29

vermillionectomy with advancement of the labial mucosa or laser ablation of the involved vermillion zone