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Oral Path II (me) > Malignancies of surface epithelial origin > Flashcards

Malignancies of surface epithelial origin Flashcards

1
Q

most common skin cancer?

A

BCC - affects over 1 million people in the U.S annually

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2
Q

risk factors BCC

A

40+ yo
fair complexion
hx of chronic sun exposure

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3
Q

where does BCC normally affect?

A

middle 1/3rd of the face

BUT any cutaneous areas of the head and neck can be affected

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4
Q

what are the 3 types of BCC?

A

nodulo-ulcerative

pigmented and sclerosing

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5
Q

what is the most common BCC clinical presentation?

A

nodulo-ulcerative

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6
Q

appearance nodulo-ulcerative bcc

A

umbilicated papule that may show central ulceration

LACK of adnexal skin structures (hair)

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7
Q

histopathology noduloulcerative BCC

A

basaloid cells that appear to “drop off” of the basal cell layer of the epidermis
*large lobules into the superficial CT of tumor cells are characteristic

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8
Q

pigmented bcc resembles

A

melanocytic nevi

*due to benign melanocytic colonization

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9
Q

how to distinguish nevus from pigmented bcc?

A

short duration and lack of hair

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10
Q

what is the least common type of BCC?

A

sclerosing

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11
Q

what is the most aggressive form of BCC?

A

sclerosing

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12
Q

what is another name for sclerosing bcc?

A

morpheaform

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13
Q

what does a sclerosing bcc resemble clinically?

A 
a scar (cicatrix)
*due to collagen formation induced by tumor cells
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14
Q

histopathology sclerosing bcc?

A

tiny infiltrative nests of tumor cells in a collagenous background
*hard to assess borders clinically due this infiltrative growth pattern

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15
Q

tx bcc

A 
scalpel excision
electrodesiccation and curettage
mohs curgery (pathology and surgery)
cryotherpy
radiation
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16
Q

prognosis bcc

A

generally excellent - 95% of patients cured after 1st tx

metastasis is RARE

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17
Q

what lesions require mohs surgery?

A

larger, recurrent lesions and tumors in areas of embryonic fusion that are more aggressive

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18
Q

what is the most common oral malignancy?

A

SCC

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19
Q

SCC is the ___ most common cutaneous malignancy

A

2nd

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20
Q

areas that are most affected by scc

A

skin and lower vermillion zone of the lip (on the face)

face, helix of the ear, dorsum of hands and arms are common sites

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21
Q

causes od cutaneous SCC

A

chronic sun (UV) exposure or after medical ionizing radiation to a specific site

** arises from pre-exisiting actinic keratosis in many instances

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22
Q

tx of cutaneous scc

A

surgical excision

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23
Q

actinically induced scc growth

A

well differentiated and grow slowly

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24
Q

prognosis of scc

A

generally good if identified early in course

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25
Q

what percent of scc are usually associated with tobacco (with or without) alcohol

A

75-80%

26
Q

20-25% of scc are not associated with identifiable risk factors, where are they located?

A

lateral tongue of younger people and gingiva of older owmen

27
Q

oncogenic HPV subtypes usually show up where when they turn to scc?

A

base of tongue and tonsils

28
Q

what type of hpv is implicated in oropharyngeal scc?

A

type 16

29
Q

does oropharyngeal scc have a better change when it is or is not associated with hpv?

A

better prognosis if HPV +

30
Q

what percent of cancers does oral scc account for?

A

3-4

31
Q

oral scc epidemiology

A

older adults

men 2: 1 to women

32
Q

risk factors oral scc

A

same as leukoplakia and erythroplakia
* alcohol??? or synergistic effect with tobacco
NOT alcoholic mouthwash

33
Q

appearance of oral scc?

A

irregular shape, mixture of red and white clinically
often ulcerated
exophytic (growing out) or endophytic (growing in) growth pattern
FIRMER than surrounding tissues

34
Q

oral scc appearance on an X-ray

A

ragged moth-eaten radiolucency with ill-defined borderes **bone involvement, so fracture is possible

35
Q

when does oral scc exhibit pain?

A

late, early lesions are usually asymptomatic

36
Q

prognosis of scc on the lip?

A

lower lip - good

upper lip - high risk for lymph node metastasis

37
Q

oral scc can develop from what?

A
  1. leukoplakia
  2. erythroplakia
  3. proliferative verrucous leukoplakia
38
Q

proliferative verrucous leukoplakia

A

leukopakia that grows laterally and involves multiple sites

39
Q

prolifertive verrucous leukoplakia female predilection

A

4: 1

* only 1/3 have traditional risk factors

40
Q

mean age of females and males with proliferative verrucous leukoplakia

A

65 yo female and 49 yo male

41
Q

oral scc common sites

A 
tongue, esp post lateral/ventral
floor of the mouth (esp near the frenum)
gingiva
labial and buccal mucosa
hard palate
42
Q

what is the most common site of oral scc involvement on the tongue

A

lateral tongue

43
Q

where does oral scc typically seen in pts that are young and have no risk factors

A

tongue

44
Q

oral scc in the floor of the mouth is usually where?

A

near the midline ** about at common as tongue ca

45
Q

is it common to have gingiva/alv mucosa oral scc?

A

no, but double as common in women at this site

**usually in people with no risk factors (i.e no smoking etc..)

46
Q

if oral scc in the hard palate often?

A

no, usaully arises on the lateral soft palate

**hard to determine if lesion developed in mx sinus and invaded through the floor

47
Q

clincial differential diagnosis of scc

A

non-specific ulcer
specific infections (tb, syphillis, deep fungal)
immune-mediated conditions (wegner, crohn)

48
Q

histopath scc

A

microscopically, invasive cords and nests of malignant sq. epithelial cells arise from dysplatic surface epi
*tumor cells show an increased nuclear/cytoplasmic ratio, cellular and nuclear pleomorphism an mitotic activity
varying degrees of keratin production may be seen ( well vs. poorly diff)

49
Q

oral scc tx

A

wide surgical excision and/or radiation therapy
chemo does NOT show any impact
neoadjuvant therapy to shrink the tumor initially
molecular-based targeted therapy are anticipated for the future

50
Q

prognosis oral scc

A

poor because pts present in stage III or IV and metastasis to regional lymph nodes

51
Q

5 year survival rate for oral scc?

A

60%, one of the worst prognoses of any major cancer

52
Q

is oral scc follow up necessary?

A

yes

53
Q

what percent of patients will develop aerodigestive tract malignancies if carcinogenic habits dont stop after oral scc?

A

10-25%

54
Q

verrucous carcinoma

A

less aggressive, relatively uncommon FORM of scc

55
Q

when does veruc ca develop

A

elderly male pts

56
Q

ver carcinoma show a correlation with smokeless tobacco?

A

No, mentioned as a contributing factor, but no association

57
Q

appearance verruc ca?

A

diffuse white or mixed red and white plaqiue

58
Q

frequent sites for verruc ca?

A

alveolar mucosa, hard palate and buccal mucosa

59
Q

verruc ca growth pattern

A

lateral

60
Q

verruc ca histology

A

very bland, often misdiagnosed

**Dx based on overall architecture of the tumor rather than the appearance of individual cells

61
Q

verruc ca tx

A

surgical excision
radiation discouraged b/c sporadic reports of transformation of verrucous ca to a more aggressive scc?? –> differing new info

62
Q

what percent of verruc ca (upon COMPLETE excision) shows foci of transformation to routine scc

A

20-25%

Oral Path II (me) (2 decks)

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