Mucosal Colour Changes Flashcards
why are lesions white
thickening of keratin layer obstructs view to the blood vessels which are responsible for providing pink colour of mucosa
thickening of mucosa / keratin = less visibility of blood and if less blood in tissues = vasoconstrictor hence why we can see blanching on admin of LA
causes of oral white lesions (5)
- hereditary
- smoking / frictional
- lichen planus (GVHD / lupus erythematosus)
- candidal leukoplakia
- carcinoma
leukoplakia
a white patch which cannot be scraped off or attributed to any other cause
no histopathological connotation (it is a clinical description)
diagnosis of exclusion
1-5% become malignant but no association with malignancy at the beginning
fordyce’s spots
ectopic sebaceous glands
seen mostly on buccal mucosa but can be seen on the lips
benign normal structures
frictional keratosis
often has obvious trauma i.e. parafunctional clenching (linea alba)
smoker’s keratosis
smokers 6x more likely to have leukoplakia
low malignant potential of the lesion but higher oral cancer risk overall
trauma from thermal gases
hereditary keratosis
white sponge naevus
not traumatic as it is right down in the sulcus
often starts in childhood spreading anteriorly and down into sulcus
if 1 family member has it other most likely will have it too
shown as fluid filled areas in superficial epithelium histologically
thickening on tuberosity
thickening as it has clear cut edge and normal surrounding mucosa so there is no reaction to the white lesion
If malignant there would be inflammatory process around the lesion. Appears as a keratosis. As there is no obvious cause it is termed idiopathic keratosis
whitening around gingiva of tooth
Could be idiopathic or trauma or desquamative gingivitis
Biopsy is necessary but would take slighter higher up as to not disrupt dento-gingival junction
chemical burn
usually from aspirin
Acidic substance in contact with mucosa has caused protein coagulation and damage to epithelial surface. Aspirin normally cause but can also be seen with alendronic acid which is taken for osteoporosis tx / prevention. Often seen in nursing homes with ptx who don’t have full cognitive function as they may not swallow tablet but hold it in their mouths for a prolonged period
side of tongue lesion
side of tongue can have hair leukoplakia which is elongation of the papilla due to incorporation of EBV but may simply be a traumatic keratosis
defined margin
this is good. undefined margins indicate uncontrolled cell division & spread i.e. malignancy
infective white lesions candidiasis
- pseudomembranous acute i.e. thrush - can be scraped off their pseudomembrane as it is not firmly attached to mucosa
- denture associated chronic - erythematous due to being in contact with candida for a prolonged period of time
infective white lesion
herpes simplex
intraepithelial vesicles that disrupt view of connective tissue blood vessels
when to refer a white lesion
- most are benign
- if red and white, concentrate on red part
- refer if lesion is becoming more raised & thickened
- if lesion is ‘without cause’ on lateral tongue, anterior floor of mouth or soft palate area
why are red lesions red
blood flow increases due to inflammation / dysplasia leading to reduced thickness of epithelium
if red lesion has bite margin & erythematous ridge
observe for a short period as it may resolve in a few weeks but if not take biopsy
erythroplakia
atrophic or non keratotic end of spectrum
a red patch which cannot be attributed to any other cause
more of a concern for malignancy than leukoplakia as it is unexplained
red / blue lesions
fluid in connective tissue:
dark = slow moving blood - varicosities; veins or cavernous haemangioma
light blue = clear fluid - saliva in mucocele or lymph in lymphangioma
vascular hamartomas
can have capillary or cavernous (related to blood) haemangioma
appears quite friable and then very red, increasing in size
take a biopsy
will increase then reduce in size suggesting it is vascular rather than a malignancy which would only tend to increase in size
lymphangioma
most are cavernous and found on tongue
takes lymph fluid from tissues back into circulation
proliferation of fluid spaces
can be indistinguishable from cavernous haemangioma until biopsy carried out
connective tissue diseases i.e. vasculitic diseases
- large vessel disease - giant cell (temporal) arteritis
- medium vessel disease - polyarteritis nodosa/ kawasaki disease
- small vessel disease - granulomatosis with polyangitis
causes of mucosal pigmentation
- exogenous stain of tea / coffee / CHX / bacterial overgrowth
- intrinsic pigmentation:
- reactive melanosis / melanotic macule (normal number of melanocytes but increased amount of melanin)
- melanocytic naevus (increased no of melanocytes all producing same amount of melanin)
- melanoma (cancer producing pigment)
- effect of systemic disease, paraneoplastic phenomenon - intrinsic foreign body i.e. amalgam, arsenic
brown / black lesions
localised = amalgam, melanotic macule, melanotic naevus, malignant melanoma
generalised = racial/familial, smoking, drugs, addison’s disease (raised ACTH conditions)
mucosal inflammation
can be acute / chronic
aetiology = trauma, infection, immunological, physical / chemical, viral / bacterial / fungal
signs & symptoms of melanoma
variable pigmentation
irregular outline
raised surface
symptomatic - itch / bleed
purpose of biopsy (3)
- identifies or excludes malignancy
- identifies dysplasia
- identifies other disease i.e. lichen planus
if you have an unexplained white red or pigmented patch
must biopsy
what should be referred to OM
- pt with abnormal and / or unexplained changes to oral mucosa
- if there is concern about dysplasia risk i.e. appearance of lesion, risk site, risk behaviour, family hx
what should not be referred to OM
asymptomatic variations of normal mucosa
benign conditions that the practitioner has diagnosed as asymptomatic, no potential of malignant risk, for which there is no tx
if unsure consider clinical photography to monitor area until next check up / send to specialist for opinion
