Mucosa Colour Changes Flashcards
Why Oral white lesions occurs?
- 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
Why are white lesions white?
- 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
What is Leukoplakia?
- 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)
Fordyce’s spot
- ectopic sebaceous glands
- benign
- pt should be reassured
Frictional keratosis
- rubbing causing thickening of mucosa, keratotic thickening
- traumatic source, parafunctional clench, buccinator muscle contraction
Smoker’s keratosis
- 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
White sponge naevus
- hereditary keratosis
- not subject to trauma
- usually start posteriorly
- usually found in other family members too
Chemical aspirin burn
- damage to epithelial surface
- alendronic acid (osteoporosis) may cause too
- pt may not swallow medication properly
Infective Candidosis
Herpes simplex
When to refer a white lesion?
- 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
Why red lesions red?
- blood flow increases due to inflammation/ dysplasia
- reduced thickness of epithelium
Why is this concerning?
- no obvious reason for this to happen
- papillary haemangioma happening from birth
- dysplasia, increase vascularity and appear much redder
- take biopsy and examine histologically
Erythroplakia
- 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
Red/Blue lesions
- fluid in CT
- dark; slow moving blood; varicosities, veins/ cavernous haemangioma
- light blue; clear fluid, saliva (mucocele), Lymph (Lymphangioma)
Vascular hamartomas
- biopsy to find out what the cause
- hamangioma
- vascular lesion
Haemangioma
- cavernous haemangioma
- little blood within CT
- red colour lesions
- carvernous haemangioma
- slow moving blood
Lymphangioma
- taking lymph fluid from tissues back to circulation
- most are carvernous
- cystic hygroma
Vasculitic disease - CT disease
- rare
Large vessel disease
- giant cell (temporal) arteritis
Medium vessel disease
- polyarteritis nodosa
- Kawasaki disease
Small vessel disease
- granulomatosis with Polyangiitis
Pigmented lesions
- external pigment
- internal pigmentation from melanocytes
Mucosal Pigmentation
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
Generalised causes of Brown/ Black lesions
- racial
- smoking
- drugs, ie: tetracyclines, stimulate melanocytes
- Addison’s disease; due to raised ACTH
Localised causes of Brown/ Black lesions
- amalgam
- melanotic macule
- melanotic nevus
- malignant melanoma
- Peutz- Jehger’s syndrome
- Pigmentary incontinence
- Kaposi’s sarcoma
Melanotic macule
Racial pigmentation
Amalgam tattoo
Raised ACTH- addisons
- make more melanin
- check BP
- check electrolyte
- hormone change pt more likely to develop pigmented skin
When to refer mucosal pigmentation?
- non- explainable
- increase in size, colour and quantity?
- new systemic problem??
Mucosal inflammation
- acute/ chronic
Aetiology
- trauma
- infection
- immunological
- physical/ chemical
- viral/ bacterial/ fungal
Is it a melanoma?
- variable pigmentation
- irregular outline
- raised surface
- is it symptomatic? itch/ bleed
Biopsy
- identify/ exclude malignancy
- identify dysplasia
- identify other disease, ie: Lichen Planus
**White, red, pigmented patch must be biopsy if unexplained
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
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
If unsure?
- clinical photographs to monitor area until next checkup
- send to specialist for an opinion
Mucocele on upper lip
- red flag
- malignancy
Polyps on gingival tissues
- fibrous epulis
- due to subgingival calculus, overhang restorations
Histology of fibrous epulis
- acanthosis
- hyperkeratosis
- elongated rete ridges
