Mucosa Colour Changes Flashcards

1
Q

Why Oral white lesions occurs?

A
  • hereditary: oral spongy nevus
  • smoking/ frictional- cause irritation
  • Lichen Planus - acanthosis, reduces visibility of epithelial blood flow, increase whiteness of mucosa
    1. Lupus erthematous
    2. GVHD
  • candidal leukoplakia
  • Carcinoma: thickening of cells
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2
Q

Why are white lesions white?

A
  • thickening of mucosa/ increase in keratin
  • gives less visibility of blood cells in CT beneath
  • less BF in tissues
  • blanching of tissue
  • vasoconstrictor and area becomes white/ pale
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3
Q

What is Leukoplakia?

A
  • a white patch which cannot be scraped off/ attributed to any other cause
  • diagnosis of exclusion
  • if due to hyperkeratosis after biopsy, then describe as hyperkeratosis
  • 1-5% becomes malignant (higher chance if leukoplakia appears due to betel nut chewing)
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4
Q

Fordyce’s spot

A
  • ectopic sebaceous glands
  • benign
  • pt should be reassured
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5
Q

Frictional keratosis

A
  • rubbing causing thickening of mucosa, keratotic thickening
  • traumatic source, parafunctional clench, buccinator muscle contraction
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6
Q

Smoker’s keratosis

A
  • reactive change
  • may have melanin pigment
  • 6x more likely to have leukoplakia
  • low malignant potential of lesions
  • consider the mouth of the pt as a high risk of oral cancer, instead of just the lesion
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7
Q

White sponge naevus

A
  • hereditary keratosis
  • not subject to trauma
  • usually start posteriorly
  • usually found in other family members too
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8
Q

Chemical aspirin burn

A
  • damage to epithelial surface
  • alendronic acid (osteoporosis) may cause too
  • pt may not swallow medication properly
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9
Q

Infective Candidosis

A
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10
Q

Herpes simplex

A
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11
Q

When to refer a white lesion?

A
  • most are benign
  • if there are red and white, focus on the red
  • if lesion is becoming more raised and thickened
  • if lesion appears without cause, ie: lateral tongue, anterior floor of mouth, soft palate area
  • take photograph with referral
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12
Q

Why red lesions red?

A
  • blood flow increases due to inflammation/ dysplasia
  • reduced thickness of epithelium
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13
Q

Why is this concerning?

A
  • no obvious reason for this to happen
  • papillary haemangioma happening from birth
  • dysplasia, increase vascularity and appear much redder
  • take biopsy and examine histologically
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14
Q

Erythroplakia

A
  • atrophic/ non-keratotic end of spectrum
  • a red patch which cannot be attributed to any other causes
  • more of a concern for malignancy than leukoplakia
  • unexplained red change
  • requires biopsy
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15
Q

Red/Blue lesions

A
  • fluid in CT
  • dark; slow moving blood; varicosities, veins/ cavernous haemangioma
  • light blue; clear fluid, saliva (mucocele), Lymph (Lymphangioma)
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16
Q

Vascular hamartomas

A
  • biopsy to find out what the cause
  • hamangioma
  • vascular lesion
17
Q

Haemangioma

A
  • cavernous haemangioma
18
Q
A
  • little blood within CT
  • red colour lesions
19
Q
A
  • carvernous haemangioma
  • slow moving blood
20
Q

Lymphangioma

A
  • taking lymph fluid from tissues back to circulation
  • most are carvernous
  • cystic hygroma
21
Q

Vasculitic disease - CT disease

A
  • rare

Large vessel disease
- giant cell (temporal) arteritis

Medium vessel disease
- polyarteritis nodosa
- Kawasaki disease

Small vessel disease
- granulomatosis with Polyangiitis

22
Q

Pigmented lesions

A
  • external pigment
  • internal pigmentation from melanocytes
23
Q

Mucosal Pigmentation

A

Exogenous stain
- tea
- coffee
- CHX
- bacterial overgrowth

Intrinsic pigmentation
- reactive melanosis - smoking
- melanotic macule
- melanocytic naevus; increase number of melanocytes
- melanoma
- effect of systemic disease, paraneoplastic phenomenon

Intrinsic foreign body
- metals, ie: amalgam, arsenic

24
Q

Generalised causes of Brown/ Black lesions

A
  • racial
  • smoking
  • drugs, ie: tetracyclines, stimulate melanocytes
  • Addison’s disease; due to raised ACTH
25
Q

Localised causes of Brown/ Black lesions

A
  • amalgam
  • melanotic macule
  • melanotic nevus
  • malignant melanoma
  • Peutz- Jehger’s syndrome
  • Pigmentary incontinence
  • Kaposi’s sarcoma
26
Q

Melanotic macule

A
27
Q

Racial pigmentation

A
28
Q

Amalgam tattoo

A
29
Q

Raised ACTH- addisons

A
  • make more melanin
  • check BP
  • check electrolyte
  • hormone change pt more likely to develop pigmented skin
30
Q

When to refer mucosal pigmentation?

A
  • non- explainable
  • increase in size, colour and quantity?
  • new systemic problem??
31
Q

Mucosal inflammation

A
  • acute/ chronic

Aetiology
- trauma
- infection
- immunological
- physical/ chemical
- viral/ bacterial/ fungal

32
Q

Is it a melanoma?

A
  • variable pigmentation
  • irregular outline
  • raised surface
  • is it symptomatic? itch/ bleed
33
Q

Biopsy

A
  • identify/ exclude malignancy
  • identify dysplasia
  • identify other disease, ie: Lichen Planus

**White, red, pigmented patch must be biopsy if unexplained

34
Q

What should be referred to OM?

A
  • pt with abnormal/ unexplained changes to oral mucosa
  • concerns about dysplasia risk
    1. appearance of lesion
    2. risk site
    3. risk behaviour
    4. family history
35
Q

NOT to be referred to OM?

A
  • asymptomatic variations of normal mucosa
  • benign conditions practitioner has diagnosed
    1. asymptomatic
    2. no potential malignant risk
    3. no tx
36
Q

If unsure?

A
  • clinical photographs to monitor area until next checkup
  • send to specialist for an opinion
37
Q

Mucocele on upper lip

A
  • red flag
  • malignancy
38
Q

Polyps on gingival tissues

A
  • fibrous epulis
  • due to subgingival calculus, overhang restorations
39
Q

Histology of fibrous epulis

A
  • acanthosis
  • hyperkeratosis
  • elongated rete ridges