Midterm Flashcards
Leukoplakia: Overview
White patch that cannot be rubbed off
Cannot be characterized as any other disease
What are the clinical features and most common sites of Leukoplakia?
ranges from thin, grayish, and translucent - rough, white/yellow, and leathery
Floor of mouth; ventrolateral tongue, lips
What ages and gender does leukoplakia effect?
Any age or gender equally
Histopathology of leukoplakia.
benign hyperkeratosis and acanthosis - epithelial dysplasia - invasive squamous cell carcinoma
What are treatment options for leukoplakia?
- Site dependent
- Long-term follow-up
- Conventional or laser excision
What is the prognosis for leukoplakia?
- Histology dependent
- Excellent - Poor
Frictional Keratosis overview:
Epithelial response to chronic trauma
What are the clinical featres for Frictional keratosis?
On palpation, it ranges from smooth to rough, irregular and leathery in consistency.
What are the most common locations Frictional Keratosis?
Lips, cheeks, and lateral tongue
What ages and genders are most commonly effected by frictional keratosis?
- Can effect any age
- No gender predilection
- Commonly found in younger
Describe the histology of Frictional Keratosis,
Hyperkeratosis and/or acanthosis
What are the treatment options for Frictional keratosis?
- Remove irritating factor
- Biopsy persisting lesions
- follow-up
- rebiopsy
What are the clinical features of Tobacco Keratosis: Snuff Dipper’s Keratosis?
Well demarcated translucent grayish to rough and wrinkled or folded with deep furrows that are white or yellow in color
Gingival recession is present
What gender and ages are commonly effected by Tobacco keratosis?
White, blue-collar males
> 18 years old
10-30 years old
What are the histological features of Tobacco keratosis?
hyperkeratosis and acanthosis
longer use: epithelial dysplasia and/or invasive carcinoma (50 fold increase)
What are the treatment options for Tobacco Keratosis?
- stop tobacco use
- excision with clean margins if dysplasia
- complete excision if in high risk locations
- long-term follow-up
What is the prognosis of Tobacco keratosis?
Good - Poor
What are the clinical features of Cigarette Smoking-Related Keratosis?
smooth, white - rough -verruciform
What gender and ages are more commonly effected by Cigarette smoking-related keratosis?
Middle-aged males
What are the common sites of Cigarette keratosis?
Buccal mucosa, mucobuccal fold, and floor of mouth
Describe the histology of Cigarette keratosis.
benign, hyperkeratosis, acanthosis, and melanin incontinece
to
epithelial dysplasia, carcinoma in situ and invasive sqamous cell carcinoma
What are the treatment options for cigarette keratosis?
Removal and excision
Pipe/Cigar: nicotinic stomatitis
A benign epithelial change of both the surface and the minor salivary gland ducts;
Leads to hyperkeratosis and acanthosis with hyperplastic dilated salivary ducts
Where is nicotinic stomatitis most commonly found?
the palate (lip cancer where pipe is being held)
What are the clinical features of nicotinic stomatitis?
- Diffuse white surface
- uniformly interspersed by small red dots (dilated salivary ducts)
Describe the histopathology of nicotinic stomatitis.
benign hyperkeratosis and acanthosis with salivary gland duct - proliferation and metaplasia
What are the treatment options for nicotinic carcinoma?
Stop smoking
examine lower lip and oro-naso pharyngeal area for SCC
What is the prognosis for nicotintic stomatitis?
depends on histology
Idiopathic Leukoplakia (keratosis) Overview.
Uncommon; histologically benign (hyperkeratosis and acanthosis)
can develop into SCC
can recur an dprogress over 1-2-30 years
What is the name of malignant Idiopathic Leukoplakia?
Proliferative verrucous leukoplakia (1/3 common smokers)
Erythroplakia overview:
Red patch that does does not represent any other disease. No histological connotation and should not be used as a diagnosis. Histological and clinical significance are much greater than leukoplakia
Erythorplakia vs. Leukoplakia
49% premalignant, 51% malignant VS. 80% benign, 17% premalignant, 3% SCC
Etiologies for erythroplakia?
tobacco and alcohol (75% of patients)
What are the high risk sites for erythroplakia?
floor of mouth; ventrolateral tongue, soft palate area
What are the clinical features of erythroplakia?
red, velvety, and well-demarcated areas
rough or smooth
rean and white (speckled) (sometimes)
ulcerated
What gender and ages are most commonly effectedy by erythroplakia?
males over 45 yo
younger patients (smoking and tobacco)
Describe the histology of erythroplakia.
mild epithelial dysplasia - CIS - SCC
Clinical tips:
- not a hemanioma = biopsy
- risk areas = biopsy
What are the treatment options for erythroplakia?
Excision
Papilloma overview
benign epithelial proliferation (may be true neoplasm of epithelial origin)
What is the etiology of papilloma?
HPV 6/11
what is the most common age papilloma occurs?
30-50 years old
What are the risk areas for papilloma?
anywhere; floor of the mouth, soft palate, tongue
What is the clinical presentation of papilloma’s?
Sessile or pedunculated, cauliflower-like keratotic lesion
Describe the histology of a papilloma.
elevated finger-like projections of proliferateing epithelial cells supported by fibrous connective tissue core
What are the treatment options for papilloma?
Excision
Verruca Vulgaris
- Common Wart
- benign lesions representing epithelial proliferation
What is the etiology of VV?
HPV 2 and 4
What are the clinical features of VV?
Indistinguishable from papilloma’s
Occurs in multiples (finger mouth)
What ages are commonly effected by VV?
20% of all children
Descrie the treatment options for VV?
thick keratin layers, alternating parakeratin and orthokeratin with granular cell layer and keratohyalin granules
Condyloma acuminatium
Venereal wart
benign papillomatous proliferation of surface epithelium
30% of all STD’s
What is/are the etiologies of conyloma acuminatum?
HPV 6/11
Sexually transmitted
What are the clinical features of condyloma acuminatum?
common in genitals, occur in oral cavity
single papillary pinkish/white lesion or multiple membranous pink and papillomatous lesions
Describe the histopathology of Condyloma acuminatum.
broad papillary projections with empty cytoplasm and meiosis
connective tissue is loose, vascular and filled with lymphoctes
How do you treat condyloma acuminatum?
chemical cauterization, surgical removal
Focal Epithelial Hyperplasia overview:
Heck’s disease.
Transmitted via contact and occurs in schools and families
Who is commonly effected by focal epithelial hyperplasia?
Native Americans, South American Indians
What are the clinical features of focal epithelial hyperplasia?
multiple lesions, slightly raised, smooth and same color as the surrounding mucosa
What age group is usually effected by focal epithelial hyperplasia?
- children younger than teenage years
- rarely in 50yo patients
- adult AIDS patients
- congested areas
Where are the most common locations of focal epithelial hyperplasia?
lip and buccal mucosa
then on the gingiva, palate and other
Treatment for focal epithelial hyperplasia?
none, spontaneously go away
Pigmented Nevi Overview:
benign neoplasms or hamartomas of melanocyte origin
Junctional nevus Overview
Rare in the mouth
common on skin
What are the clinica features of Junctional Nevus?
flat, well demarcated, brown
3% of all nevi in the oral cavity
Describe the histology of a Junctional nevus.
nevus cells at the jucntion of the surface epithelium and underlying fibrous connective tissue
Melanin pigment is present
Intramucosal Nevus Overview:
most common nevus of the oral cavity 55%
What are the clinical features of intramucosal nevi?
elevated, papillary lesion, brown and/or amelanotic (pink)
What is the most common location of intramucosal nevi?
gingiva
Describe the histology of intramucosal nevi?
Aggregates and theaques of nevus cells in fibrous connective tissue, separate from the surface by a band of fibrous connective tissue
Compund Nevus overview:
6% of all oral nevi
Brown elevated nodule
anywhere in the oral cavity
Describe the histology of compund nevi.
aggregates of nevus cells present at the epithelial junctions and vibrous connective tissue
melanin pigment within nevus cells and surronding tissue
Blue Nevus Overview
36% of oral nevi
What are the clinical features of blue nevus?
slightly raised; bluish-black lesion
Most common on the palate
Describe the histopathology of Blue nevus?
spinle-shaped nevus cells
in teh deeper portion of connective tissue parallel to collagen bundle
lots of melanin pigment
Treatment options for blue nevus
excision (masticatory friction)
Oral Squamous cell Carcinoma Overview
most common malignant neoplasm of the mouth
90% of all malignant neoplasms in the oral cavity
What is the more common gender and age for SCC?
55 year old MEN or >60 men
young adults with history of tobacco chew
What are the most common locations of SCC?
lateral and ventral tongue; floor of the moth, gingiva
Clinical presentation of SCC?
benign - malignant looking
mistaken for lymphadenopathy
non-healing ulcer; red, red/white lesions; ulcers with rolled borders; fungating; fixation induration
What are the main risk factors for SCC?
tobacco and aclohol
