Mucosal Colour Changes Flashcards

1
Q

What can cause oral white lesions?

A
  • hereditary lesions
  • smoking/frictional
  • lichen planus
  • candidal leukoplakia
  • carcinoma
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2
Q

What hereditary condition can cause white lesions in the mouth?

A

Oral white sponge nevus

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3
Q

Why are white lesions white?

A

Thickening of the mucosa or keratin (keratosis)
- less visibility of blood

Less blood in the tissues
- vasoconstrictor

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4
Q

What does the word leukoplakia mean?

A

A white patch which cannot be scraped off or attributed to any other cause
- no histopathological connotation
- diagnosis of exclusion

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5
Q

What are fordyce’s spots?

A

benign ectopic sebaceous glands
- oral mucosa is from skin rather than gut tube, so normal to form sebaceous glands !

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6
Q

What is frictional keratosis?

A

Usually traumatic source, an example would be parafunctional clench habit
(linea alba)

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7
Q

What causes smoker’s keratosis?

A

Trauma from thermal gasses which causes thickening of keratin layer
- you will also see melanin pigments in the histological view

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8
Q

How much more likely are smokers to have leukoplakia?

A

6 times more likely

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9
Q

How does white sponge nævus present?

A

Starts posteriorly usually and spread anteriorly and down/up into sulcus
- histologically caused by fluid accumulating between the epithelial cells, fluid makes it difficult to see through epithelium, causing white appearance

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10
Q

If there is a clearly defined white lesion, with normal mucosa surrounding it would you be concerned?

A

Lower risk of being malignant if there is no surrounding inflammatory response to the white lesion

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11
Q

What might dispersed white lesions on the palate that can be rubbed off be?

A

Pseudomembranous candida

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12
Q

When should you refer a white lesion?

A
  • If the lesion is RED and WHITE concentrate on the RED part !!! (inflammatory margin)
  • If the lesion is becoming more raised and thickened
  • If the lesion is ‘without cause’ (lateral tongue, anterior floor of mouth, soft palate area)
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13
Q

Why are red lesions red?

A
  • Blood flow increases (inflammation or dysplasia)
  • Reduced thickness of the epithelium
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14
Q

What is erythroplakia?

A

Atrophic or non-keratitic red lesion (a red lesion which cannot be attributed to any other cause)
- more of a concern for malignancy than leukoplakia a

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15
Q

What causes red/blue lesions within the mouth?§

A

Fluid in the connective tissue
- Dark = slow moving blood (varicosities)
- Light blue = clear fluid (saliva, lymph)

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16
Q

What connective vasculitic tissue diseases may cause mucosal changes within the mouth?

A
  • Giant cell (temporal) arteritis
  • Polyarteritis nodosa
  • Granulomatosis with Polyangitis
17
Q

What can cause mucosal pigmentation?

A
  • Exogenous stain of tea/coffee/chlorhexidine/bacterial overgrowth
  • Intrinsic pigmentation
  • Intrinsic of foreign body
18
Q

What are some causes of intrinsic pigmentation of the mucosa?

A
  • Reactive melanosis (eg smoking)
  • Melanocytic nævus (melanocyte is becoming abnormal)
  • Melanoma (cancer producing pigment)
  • Effect of systemic disease
19
Q

What are some localised causes of brown or black lesions?

A
  • amalgam tattoo
  • melanotic macule
  • melanotic nævus
  • malignant melanoma
  • peutz-jehger’s syndrome
  • pigment are incontinence
  • kaposi’s sarcoma
20
Q

What are some generalised causes of brown or black lesions?

A
  • racial/familial
  • smoking
  • drugs
  • addison’s disease (raised ACTH conditions)
21
Q

What drugs can cause brown or black lesions in the mouth?

A

Oral contraceptive pill
Tetracyclines

22
Q

If you suspect a patient has brown/black oral lesions caused by raised ACTH (addisons) what should you do?

A
  • check BP
  • arrange for electrolyte check
23
Q

What are the characteristic features of a melanoma?

A
  • variable pigmentation
  • irregular outline
  • raised surface
  • symptomatic (itchy or bleeding)
24
Q

What are the reasons for doing a biopsy?

A
  • identifies or excludes malignancy
  • identifies dysplasia
  • identifies other disease (eg lichen planus)