Mucosal Colour Changes Flashcards
What can cause oral white lesions?
- hereditary lesions
- smoking/frictional
- lichen planus
- candidal leukoplakia
- carcinoma
What hereditary condition can cause white lesions in the mouth?
Oral white sponge nevus
Why are white lesions white?
Thickening of the mucosa or keratin (keratosis)
- less visibility of blood
Less blood in the tissues
- vasoconstrictor
What does the word leukoplakia mean?
A white patch which cannot be scraped off or attributed to any other cause
- no histopathological connotation
- diagnosis of exclusion
What are fordyce’s spots?
benign ectopic sebaceous glands
- oral mucosa is from skin rather than gut tube, so normal to form sebaceous glands !
What is frictional keratosis?
Usually traumatic source, an example would be parafunctional clench habit
(linea alba)
What causes smoker’s keratosis?
Trauma from thermal gasses which causes thickening of keratin layer
- you will also see melanin pigments in the histological view
How much more likely are smokers to have leukoplakia?
6 times more likely
How does white sponge nævus present?
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
If there is a clearly defined white lesion, with normal mucosa surrounding it would you be concerned?
Lower risk of being malignant if there is no surrounding inflammatory response to the white lesion
What might dispersed white lesions on the palate that can be rubbed off be?
Pseudomembranous candida
When should you refer a white lesion?
- 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)
Why are red lesions red?
- Blood flow increases (inflammation or dysplasia)
- Reduced thickness of the epithelium
What is erythroplakia?
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
What causes red/blue lesions within the mouth?§
Fluid in the connective tissue
- Dark = slow moving blood (varicosities)
- Light blue = clear fluid (saliva, lymph)
What connective vasculitic tissue diseases may cause mucosal changes within the mouth?
- Giant cell (temporal) arteritis
- Polyarteritis nodosa
- Granulomatosis with Polyangitis
What can cause mucosal pigmentation?
- Exogenous stain of tea/coffee/chlorhexidine/bacterial overgrowth
- Intrinsic pigmentation
- Intrinsic of foreign body
What are some causes of intrinsic pigmentation of the mucosa?
- Reactive melanosis (eg smoking)
- Melanocytic nævus (melanocyte is becoming abnormal)
- Melanoma (cancer producing pigment)
- Effect of systemic disease
What are some localised causes of brown or black lesions?
- amalgam tattoo
- melanotic macule
- melanotic nævus
- malignant melanoma
- peutz-jehger’s syndrome
- pigment are incontinence
- kaposi’s sarcoma
What are some generalised causes of brown or black lesions?
- racial/familial
- smoking
- drugs
- addison’s disease (raised ACTH conditions)
What drugs can cause brown or black lesions in the mouth?
Oral contraceptive pill
Tetracyclines
If you suspect a patient has brown/black oral lesions caused by raised ACTH (addisons) what should you do?
- check BP
- arrange for electrolyte check
What are the characteristic features of a melanoma?
- variable pigmentation
- irregular outline
- raised surface
- symptomatic (itchy or bleeding)
What are the reasons for doing a biopsy?
- identifies or excludes malignancy
- identifies dysplasia
- identifies other disease (eg lichen planus)
