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
Localised causes of Brown/ Black lesions
- amalgam - melanotic macule - melanotic nevus - malignant melanoma - Peutz- Jehger's syndrome - Pigmentary incontinence - Kaposi's sarcoma
26
Melanotic macule
27
Racial pigmentation
28
Amalgam tattoo
29
Raised ACTH- addisons
- make more melanin - check BP - check electrolyte - hormone change pt more likely to develop pigmented skin
30
When to refer mucosal pigmentation?
- non- explainable - increase in size, colour and quantity? - new systemic problem??
31
Mucosal inflammation
- acute/ chronic Aetiology - trauma - infection - immunological - physical/ chemical - viral/ bacterial/ fungal
32
Is it a melanoma?
- variable pigmentation - irregular outline - raised surface - is it symptomatic? itch/ bleed
33
Biopsy
- identify/ exclude malignancy - identify dysplasia - identify other disease, ie: Lichen Planus **White, red, pigmented patch must be biopsy if unexplained
34
What should be referred to OM?
- 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
NOT to be referred to OM?
- asymptomatic variations of normal mucosa - benign conditions practitioner has diagnosed 1. asymptomatic 2. no potential malignant risk 3. no tx
36
If unsure?
- clinical photographs to monitor area until next checkup - send to specialist for an opinion
37
Mucocele on upper lip
- red flag - malignancy
38
Polyps on gingival tissues
- fibrous epulis - due to subgingival calculus, overhang restorations
39
Histology of fibrous epulis
- acanthosis - hyperkeratosis - elongated rete ridges