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AU'18 Oral Path II > Malignancies of Surface Epithelial Origin > Flashcards

Malignancies of Surface Epithelial Origin Flashcards

1
Q

neoplasm

A

new and abnormal growth, specifically one in which cell multiplication is uncontrolled and progressive

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2
Q

T/F: neoplasms are benign

A

false; may be benign or malignant

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3
Q

malignancies of surface epithelial origin

A
  1. basal cell carcinoma
  2. cutaneous squamous cell carcinoma
  3. squamous cell carcinoma of the lip
  4. oral squamous cell carcinoma
  5. verrucous carcinoma
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4
Q

where does basal cell carcinoma arise from?

A

basal cells of the epidermis

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5
Q

what is the most common skin cancer?

A

basal cell carcinoma

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6
Q

how many basal cell carcinoma cases are diagnosed annually in the US?

A

over 1 million cases

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7
Q

risk factors of basal cell carcinoma

A
  1. age (esp. over 40 y.o.)
  2. fair complexion
  3. chronic and intermittent sun (UV) exposure
  4. frequent sunburns
  5. outdoor occupation or hobby
  6. tendency for freckling in childhood
  7. other: PUVA for psoriasis, tanning beds, immunosuppression
  8. basal cell carcinoma syndrome
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8
Q

T/F: females are more at risk for developing basal cell carcinoma

A

false; male>female

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9
Q

where does basal cell carcinoma affect?

A

any cutaneous site

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10
Q

what percent of the sites basal cell carcinoma affect is head and neck?

A

80%

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11
Q

which area on the head and neck is the most common location affected by basal cell carcinoma?

A

middle 1/3 of face (mask area)

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12
Q

what does the mask area include?

A

includes top of the eyebrows to top of upper lip; includes ears

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13
Q

types of basal cell carcinoma

A
  1. nodulo-ulcerative BCC
  2. pigmented BCC
  3. sclerosing (morpheaform) BCC
  4. others: superficial BCC, BCC associated with syndromes, fibroepithelioma
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14
Q

what is the most common type of BCC?

A

nodulo-ulcerative BCC

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15
Q

what is the least common type of BCC?

A

sclerosing (morpheaform) BCC

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16
Q

clinical features of nodulo-ulcerative BCC

A
  1. firm, painless papule
  2. slow enlargement
  3. central umbilication (depression) which often ulcerates
  4. rolled borders
  5. pearly, opalescent when pressed
  6. no hair
  7. telangiectasia
  8. hx of intermittent bleeding then healing
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17
Q

telangiectasia

A

collection of small blood vessels near surface

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18
Q

histopathologic features of nodulo-ulcerative BCC

A
  1. uniform, ovoid, dark-staining basaloid cells
  2. basaloid cells appear to “drop off”
  3. large lobules of basaloid tumor cells
  4. palisading basal cells
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19
Q

what does pigmented BCC resemble?

A

melanocytic nevi (moles)

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20
Q

clinical features of pigmented BCC

A

hx of short duration and lack of hair support BCC vs. nevus

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21
Q

histopathologic features of pigmented BCC

A

most are nodulo-ulcerative pattern, with large lobules of tumor cells invading the superficial CT

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22
Q

why are lesions of pigmented BCC pigmented?

A

colonization by BENIGN melanocytes

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23
Q

what is the most aggressive type of BCC?

A

sclerosing (morpheaform) BCC

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24
Q

clinical features of sclerosing BCC

A
  1. more firm than surrounding skin; resembles scar due to induction of collagen formation by tumor cells
  2. difficult to assess borders
  3. no hx of trauma or surgery
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25
Q

histopathologic features of sclerosing BCC

A

tiny infiltrative nests of tumor cells in a collagenous background

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26
Q

why is it difficult to clinically assess borders of sclerosing BCC?

A

due to the infiltrative growth pattern

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27
Q

treatment for BCC

A
  1. scalpel excision
  2. electrodesiccation and curettage
  3. cryotherapy
  4. radiation therapy
  5. Mohs micrographically controlled surgery; uses pathology and surgery
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28
Q

prognosis of BCC

A

generally excellent

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29
Q

what percent of patients are cured of BCC after their first treatment?

A

95%

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30
Q

T/F: larger BCC lesions, recurrent lesions and tumors in areas of embryonic fusion are more aggressive and require Mohs surgery

A

true

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31
Q

T/F: metastasis is often reported with BCC

A

false; metastasis is rarely

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32
Q

cicatrix

A

scar of a healed wound

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33
Q

types of squamous cell carcinoma (SCC)

A
  1. cutaneous (skin) SCC
  2. SCC of the lip
  3. oral squamous cell carcinoma (OSCC)
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34
Q

what is the most common oral malignancy?

A

SCC

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35
Q

what percent of oral malignancies are SCC?

A

90%

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36
Q

what is the 2nd most common cutaneous malignancy?

A

SCC

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37
Q

where does SCC arise from?

A

surface epithelium/epidermis

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38
Q

on rare occasions, SCC can arise from what?

A

salivary ductal epithelium

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39
Q

risk factors for cutaneous SCC

A
  1. chronic sun (UV) light exposure
  2. medical ionizing radiation
  3. pre-existing actinic keratosis
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40
Q

where does cutaneous SCC affect?

A

any sun-exposed site

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41
Q

what percent of cutaneous SCC cases affect the head and neck?

A

70% (i.e. face, helix of ear, scalp esp. with thinning hair)

42
Q

clinical features of cutaneous SCC

A
  1. non-healing ulcer
  2. slow growth
  3. plaque, papule or nodule
  4. variable degrees of scale, ulcer or crust
  5. often erythematous base
43
Q

histopathologic features of cutaneous SCC

A

generally well-differentiated

44
Q

treatment for cutaneous SCC

A

surgical excision

45
Q

prognosis of cutaneous SCC

A

good if identified and treated early

46
Q

common site for SCC of lip

A

lower lip; rare on upper lip since protected by forehead, nose and mustache

47
Q

clinical features of SCC of lip

A
  1. chronic (UV) sun exposure
  2. rough, scaly
  3. often ulcerated
  4. slow growing, non-healing
  5. arises in setting of actinic cheilitis
48
Q

histopathologic features of SCC of lip

A

usually well-differentiated

49
Q

treatment of SCC of lip

A
  1. scalpel excision
  2. vermilionectomy “lip shave”
  3. reduce sun exposure
  4. use SPF products
50
Q

prognosis of SCC of lip

A

good overall if ID’d early

51
Q

prognosis of SCC of lip for lower lip

A

relatively good

52
Q

prognosis of SCC of lip for upper lip

A

high risk for lymph node metastasis

53
Q

what is the most common oral malignancy

A

oral squamous cell carcinoma (OSCC)

54
Q

what percent of all cancers in US is OSCC?

55
Q

what percent of OSCC cases are not associated with any identifiable risk factor

56
Q

OSCC usually occurs in people of what age?

A

usually < 40 yo

57
Q

where does OSCC usually occur?

A

lateral/ventral tongue

58
Q

etiology of OSCC

A

multifactorial

59
Q

T/F: heredity plays a major role in OSCC

A

false, not a major role except a few heritable conditions

60
Q

EXTRINSIC risk factors of OSCC

A
  1. tobacco smoke
  2. ETOH + TOB use
  3. use of alcohol-containing mouthwash (>25%) more than 8x per day
  4. hx sanguinaria dental products (Viadent)
  5. use of betel quid
  6. reverse smoking
  7. hx radiation to head/neck
  8. smokeless tobacco (dry snuff)
  9. occupational exposure
  10. bacteria (i.e. tertiary syphilis)
  11. oncogenic viruses (HIV, small sub-set HPV)
  12. biopsy proven oral epithelial dysplasia or SCC
  13. presence of erythroplakia or PVL
  14. leukoplakia in high-risk site
61
Q

INTRINSIC risk factors of OSCC

A
  1. male >50 yo
  2. malnutrition
  3. iron deficiency anemia
  4. immunosuppression
  5. heredity not major role; few heritable conditions
62
Q

how many carcinogens does tobacco smoke have?

A

more than 70

63
Q

what percent of patients dx’d with OSCC have hx TOB use?

64
Q

how many years after smoking cessation does your risk decrease to ~non-smoker?

A

after 10 years

65
Q

T/F: risk of OSCC increases with amount smoked and number of years

66
Q

pack year tobacco

A

estimate of lifetime tobacco exposure and is used as a risk factor

67
Q

pack/year TOB

A

number of packs of cigarettes per day x number of years smokes

68
Q

ETOH alone is reported to be a risk factor if how many drinks are consumed a day?

A

> 4 drinks/day

69
Q

clinical features of OSCC

A
  1. older male >50
  2. 2:1 male predilection
  3. possibly pain (usually a late feature)
70
Q

most common sites for OSCC

A
  1. tongue (esp. posterior/lateral/ventral)
  2. floor of mouth (often near midline)
  3. gingiva
  4. soft palate (esp. posterior/lateral)
  5. labial and buccal mucosa
  6. hard palate
71
Q

T/F: men are more commonly seen with OSCC in their gingiva

A

false; women 2:1; often non-smoker

72
Q

high risk sites for OSCC

A
  1. ventro-lateral tongue
  2. floor of mouth
  3. soft palate
73
Q

clinical features of OSCC

A
  1. exophytic
  2. endophytic
  3. rolled borders esp. with endophytic
  4. color from normal to white to red
  5. firm, rubbery or indurated
  6. often ulcerated
74
Q

what can OSCC resemble clinically?

A

a non-specific ulcer infection (TB, syphilis, deep fungal) or ulcerated immune-mediated condition

75
Q

differential diagnosis

A

list of diseases/disorders which could produce signs and symptoms of a condition

76
Q

T/F: differential diagnosis is listed in descending order of most to least likely

77
Q

radiographic features of OSCC

A
  1. bone invasion usually a late feature
  2. “moth-eaten” radiolucency, ill-defined margins
  3. pathologic fracture possible
78
Q

histopathologic features of OSCC

A
  1. invasive cords and nests of malignant epithelial cells arising from dysplastic epithelium
  2. increased nuclear/cytoplasmic ratio, pleomorphism, mitoses
  3. varying degrees keratin production
79
Q

treatment for OSCC

A
  1. wide surgical excision
  2. radiation therapy
  3. chemotherapy
  4. all/combos of above
  5. neoadjuvant therapy to shrink tumor initially
80
Q

prognosis of OSCC

A

depends on stage but generally poor

81
Q

most OSCC present in what stage?

A

stage III or IV

82
Q

purpose of staging OSCC

A
  1. determines how far cancer has spread
  2. guides treatment
  3. guides prognosis
83
Q

staging CATEGORIES OSCC

A

TNM staging system
T - tumor size
N - lymph nodes
M - metastasis

84
Q

stage grouping

A

combines TNM parameters

85
Q

T/F: group 0 - IV in order of increasing severity when stage grouping SCC

86
Q

recurrent cancer is what stage in TNM system?

87
Q

what should be done after tx of OSCC is completed?

A

periodic follow-up after tx

88
Q

what percent of patients with OSCC will develop new upper aerodigestive tract malignancies especially if carcinogenic habits are continued?

89
Q

what is the most uncommon form of SCC?

A

verrucous carcinoma

90
Q

T/F: although verrucous carcinoma the more uncommon form of SCC, it is the most aggressive form

A

false; less aggressive

91
Q

what is verrucous carcinoma associated with?

92
Q

T/F: verrucous carcinoma is only seen in the oral cavity

A

false; was seen in multiple other sites including but not limited to soles of feet, genitals and ear canal

93
Q

clinical features of verrucous carcinoma

A
  1. elderly male
  2. diffuse
  3. usually extensive by tiem of dx
  4. well-defined
  5. painless
  6. thick plaque, papillary verruciform projections
  7. white, erythematous, pink - depends on amount of keratin
94
Q

oral sites affected by verrucous carcinoma

A
  1. mandibular buccal vestibule
  2. buccal mucosa
  3. gingiva
  4. tongue
  5. hard palate
95
Q

radiographic features of verrucous carcinoma

A

same as conventional SCC with bone invasion

96
Q

histopathologic features of verrucous carcinoma

A
  1. microscopically bland
  2. dx based on overall architecture, individual cells not very dysplastic
  3. wide, pushing rete ridges
  4. rough papillary surface
  5. keratin plugging
97
Q

treatment for verrucous carcinoma

A

surgical excision (neck dissection if lymph nodes +)

98
Q

why is radiation discouraged in treating verrucous carcinoma?

A

due to sporadic cases transformation to a more aggressive SCC

99
Q

prognosis of verrucous carcinoma

A

90% disease-free after 5 years

100
Q

treatment failures of verrucous carcinoma is related to what?

A
  1. underlying systemic illness prohibiting extensive surgery

2. failure to identify conventional SCC in tumor

AU'18 Oral Path II (31 decks)

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