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Oral Pathology #2 > Malignancies of Surface Epithelial Origin > Flashcards

Malignancies of Surface Epithelial Origin Flashcards

1
Q

what are the 4 malignancies of surface epithelial origin

A
  • basal cell ca
  • cutaneous SSC
  • oral SSC
  • verrucous Ca
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2
Q

where does basal cell Ca come from?

A

basal cells of the epidermis

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3
Q

what is significant about basal cell Ca

A

most common skin cancer (over 1 million cases dx annually in the US

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4
Q

who is most affected by basal cell Ca?

A

-pts over 40 who have a fair complexion and a hx of chronic sun exposure

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5
Q

where is basal cell Ca most often found?

A
  • middle third of the face

- be aware that any cutaneous area of the head and neck may be affected though

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6
Q

what is the most common clinical presentation of basal cell Ca?

A

nodulo-ulcerative type

umbilicated papule that may show central ulceration
(lack of adnexal skin structures like hair)

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7
Q

what is the histology of basal cell Ca?

A
  • basaloid cells that appear to “drop off” of the basal cell layer of the epidermis
  • pigmented basal cells are NOT rare
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8
Q

what is the histology of nodulo-ulcerative basal cell Ca?

A

large lobules of tumor cells are characteristics

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9
Q

what does basal cell Ca resemble?

A

melanotic nevi due to the presence of benign melanocytic colonization

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10
Q

what should help to distinguish basal cell Ca from a nevus?

A
  • hx of short duration

- lack of hair

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11
Q

why are basal cell lesions often pigmented?

A

colonization by benign melanocytes

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12
Q

what is unique about sclerosing (morpheaform) basal cell Ca?

A

it is the least common, but the most aggressive

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13
Q

what is the clinical appearance of sclerosing (morpheaform) basal cell Ca?

A

resembles a scar due to the induction of collagen formation by the tumor cells

  • characterized by tiny infiltrative nests of tumor cells in a collagenous background
  • very difficult to assess borders clinically bc of this infiltrative growth pattern
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14
Q

what are the tx options of basal cell Ca?

A
  • scapel excision
  • electrodesiccation and curretage
  • mohs microscopically controlled surgery, uses pathology and surgery
  • cryotherapy
  • radiation therapy
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15
Q

what is the px for basal cell Ca?

A
  • generally excellent, with over 95% of pts cured after tx

- rare metastisis is supported

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16
Q

what types of lesions of basal cell Ca require Mohs surgery?

A
  • larger lesions
  • recurrent lesions
  • tumors in areas of embryonic fusion

*bc they are all more agressive

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17
Q

what is significant about SSC?

A

-most common oral malignancy and second most common cutaneous malignancy

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18
Q

where does SSC come from?

A

surface epi cells

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19
Q

where is SSC most often found?

A

skin and lower vermillion zone of the lip cancers are due to UV light eposure

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20
Q

where does cutaneous SSC come from?

A
  • arises from pre-existing actinic keratosis

- due mainly to chronic sun exposure, can also be from medical ionizing radiation to specific site

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21
Q

where is cutaneous SSC most often found?

A
  • face
  • helix of ear
  • dorsum of hands
  • arms
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22
Q

what is the tx of cutaneous SSC

A

surgical excision

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23
Q

what type of SSCs are generally well-differentiated and grow slowly?

A

actinically-induced SSC

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24
Q

75-80% of oral SSCs are often associated with what?

A

tobacco (cigs) with or without alcohol

25
Q

of the 20% of oral SSCs that are NOT associated with tobacco use, where and whom do they affect?

A
  • lateral tongue of young ppl

- gingiva of older women

26
Q

where is oncogenic HPV subtypes of oral SSC found?

A

base of tongue and tonsils

27
Q

which type of HPV is implicated in oropharyngeal SSC?

A

type 16

28
Q

which has a better px: HPV+/- oropharyngeal SSC?

A

HPV +

29
Q

oral SSC accounts for about how much of all cancers in the US?

A

3-4%

30
Q

who does oral SSC most often occur in?

A
  • older males

- males 2:1

31
Q

what are the risk factors for oral SSC

A
  • same as leukoplakia and erythroplakia
  • tobacco (maybe alcohol)

*there is NO link with mouthwashes

32
Q

what are the clinical features of oral SSC?

A
  • irregular shape, mixture of red and white clinically
  • often ulcerated
  • exophytic (growing out)
  • endophytic (growing in)
  • much firmer than surrounding tissues
33
Q

what in unique about pain in reference to oral SSC?

A

a late feature, so often ppl do not come in for tx until it is far into its course

*ragged radioleucency is characteristic of bone involvement

34
Q

what could possibly cause SSC on the lip?

A 
actinic cheilitis (along with ultraviolet light)(secondarily)
-slow growing, well-differentiated lesions usually
35
Q

which location of SSC has a better px: upper or lower lip?

A

lower lip

  • upper has high risk for lymph node metastasis, however, SCC on upper lip is rare
  • pt neglect can result in considerable destruction
36
Q

what three things does oral SCC arise from?

A
  • leukoplakia
  • erythroplakia
  • proliferative verrucous leukoplakia
37
Q

what is proliferative verrucous leukoplakia?

A
  • leukoplakia that grows laterally and involves multiple sites
  • females more with only 1/3 having traditional risk factors
  • 65yo for females and 49yo for males
38
Q

from most common to least common, what are the sites for oral squamous cell Ca?

A
  • tongue (post/lat/vent)(post is highest risk)
  • FOM, near frenum
  • gingiva
  • labial and buccal mucosa
  • hard palate (very rare)
39
Q

what is the MOST COMMON site of oral SCC?

A

lateral tongue

40
Q

most pts with oral SCC have a hx with what?

A

smoking and alcohol abuse

41
Q

when oral SCC is seen in YOUNGER pts, it almost ALWAYS develops at what site?

A

lateral tongue

42
Q

is alcohol alone a risk factor for oral SCC?

A

no, must have smoking too

43
Q

oral SCC at the gingiva is more common for men/women?

A

women

*more common in pts with no identifiable risk factors for oral SCC (often a non-smoker)

44
Q

most oral SCC that arise on the palate arise where on the palate?

A

lateral soft palate

45
Q

why is it difficult to dx an oral SCC on the palate

A

difficult to determine whether lesion developed in max sinus and invaded through the floor

46
Q

what are the differential dxs for oral SCC?

A
  • non-specific ulcers - gone in a few weeks
  • specific infections - TB, syphillis, fungal infections
  • immune mediated conditions - wegner’s granulomatosis and crohn’s disease
47
Q

what does oral SCC appear as radiographically?

A
  • due to direct invasion of bone, radioleucency is often a late phenomenon
  • ragged “moth eaten”
  • ill-defined borders
  • pathologic fracture is possible
48
Q

what are the histological features of SSC?

A
  • invasive CORDS and NESTS of malignant squamous epi cells arise from DYSPLASTIC surface epi
  • tumor cells show and inc nuclear/cytoplasmic ratio, cellular and nuclear pleomorphism, and mitotic activity
  • varying degrees of keratin production may be seen (well vs poorly defined)

***she said “big nucleus, irregular shape, abnormal mitosis”

49
Q

what is the tx for oral SCC?

A
  • wide surgical excision and/or radiation therapy
  • chemo has NOT shown much impact
  • neoadjuvant therapy to shrink the tumor initially
  • molecular based targeted therapies are anticipated for the future
50
Q

what is the px for oral SCC?

A

gernerally poor bc pts present in stage III or IV (bc dont get pain until then)

  • metastasis to regional lymph nodes
  • at 60% 5-year survival, it is one of the worst pxs of any mojor cancer
51
Q

what is needed after tx is completed for oral SCC?

A

periodic follow-up exam after tx
-10-25% of these pts will develop new upper aerodigestive tract malignancies, particularly if carcinogenic habits are continued

52
Q

less aggressive, realatively uncommon form of SCC

A

verrucous ca

53
Q

who does verrucous ca usually develop in?

A

elderly males

54
Q

what is often a contributing factor for verrucous ca?

A

SMOKELESS TOBACCO particullary in southern states

-women who use dry snuff

55
Q

what is the clinical presentation of verrucous ca?

A

diffuse white or mixed red and white plaque that tends to grow LATERALLY

56
Q

where in the mouth is verrucous ca usually found?

A
  • alveolar mucosa
  • hard palate
  • buccal mucosa
  • grows laterally
57
Q

what is the dx of verrucous ca based on?

A

overall architecture of the tumor, rather than the appearance of individual cells in a histological sense

58
Q

what is the treatment for verrucous ca?

A
  • surgical excision is generally recommended

- radiation therapy has been DISCOURAGED due to sporadic reports of transformation to more aggressive SCC

59
Q

how likely is verrucous ca to transform to routine SCC?

A

20-25% of verrucous ca’s show foci of transformation to routine SCC

Oral Pathology #2 (4 decks)

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