Mucosal lesions Flashcards
Transition areas from normal skin to mucosa
eyelids lips gingiva, tongue, buccal mucosa genital region anal region
Histology of mucosa and mucocutaneous transition zone
- Progressive reduction in stratum corneum from several keratotic layers to none.
- . No granular, nor a horny layer - exception - dorsum of the tongue and hard palate.
- . Underlying connective tissue, called lamina propria is similar in composition and structure to the dermis of the skin.
Histology of interface between mucosal epithelium and connective tissue in cheek, labial, and alveolar mucosa.
- . relatively flat interface between mucosal epithelium and connective tissue with short papillae and wide rete ridges
- . thin keratinized epithelium of the transition zone between the skin and labial mucosa. (vermilion) with long connective tissue papillae containing numerous superficially located capillaries, which contribute to clinical red appearance of this structure.
Histology of vulvar and glans
- vulvar vestibule has non-keratinized superficial layer, indistinct lower layers composed of loosely packed, polygonal cells and a basal layer.
- glans and inner surface of prepuce are lined with variably keratinized squamous epithelium.
Melanocytes in the mucosa found in …
the basal layer
(variation between and within individuals. Pigmentation related to melanocyte activity is rarely seen in light skinned individuals.)
Benign mucosal lesions
- Melanocytic macule
- Acquired melanocytic nevus
- Congenital nevus
- Hemangioma/angiokeratoma
- Adenoma
- Fibroma
- Amalgam (tattoo)
Melanocytic macule dermoscopy
homogenous brown color
Lines, dots or structureless
Melanocytic macule histopath
basal hyperpigmentation of epithelium without significant hyperplasia of melanocytes
Melanocytic macule syndromes
Laugier-Hunziker
Peutz-Jeghers
Acquired melanocytic nevus Dermoscopy
homogenous brown colour - more brown
rarely grey and black colours
lines, dots, clods and structureless
more lines and dots
Congenital nevus Dermoscopy
Typically homogenous brown colour
Clods
Structureless areas
Angioma Dermoscopy
Red and blue colours
Clods
Structureless areas
Possible white lines (Fibrosis)
Amalgam “tattoo” Dermoscopy
Blue, grey and white colours
Structureless areas.
May be difficult to distinguish from malignancy - need clinical context - relationship to amalgam
Components of amalgam
Mixture of silver, tin, mercury, copper, zinc
Molluscum contagiosum Dermoscopy
White colour
Clods (white) with structureless areas at periphery
possible crown vessels at periphery in advanced cases
Herpes labialis Dermoscopy
Yellow and or light brown colours
Structureless areas
Possible erosion/ ulceration
Papilloma Dermoscopy
One or multiple white clods
+/- white lines at periphery
Lichen sclerosis Dermoscopy
Hallmark is whitish streaks + structureless areas
+/- zones of reddish and bluish colours, representing hemorrhagic areas.
Streaks
Structureless areas
Lichen sclerosis inflammatory, Dermoscopy
Structureless areas
Red and blue colours = hemorrhagic areas
Lines, streaks
Papilloma is thought to be associated with …
HPV infection.
Oral papilloma, presentation.
Papules or exophytic nodules with numerous finger-like surface projections.
Melanoma, early, Dermoscopy features
lines, dots, clods, structureless
low degrees of colour variegation (brown, red, grey, black, red, purple, white)
Melanoma, invasive, Dermoscopy features
lines, dots, clods, structureless
high degrees of colour variegation
Bowen’s disease Dermoscopy features
Peripheral dots and structureless areas with red, grey or black colours.
Black dots at periphery represent vessels arranged in linear fashion.
Bowenoid papulosis - features
Low grade SCC in situ
Associated with HPV
Younger males
Behaves in benign fashion
Bowenoid papulosis - macroscopic
Multiple slight elevated papule, red-violet to brown black in colour.
Bowenoid papulosis - Dermoscopy
Lines and structureless areas
Brown, grey and black colours
Diagnostic model presented by IDS
presence of blue, grey or white colour
with or without presence of structureless areas
should raise suspicion of malignancy
Diagnostic modes IDS: Sensitivity and specificity
100
82
Indication for biopsy
- Presence of blue, grey or white colours,
Esp if associated with structureless areas. - Unclassifiable mucosal lesion with hx of change.
- Patient > 45 years with unknown hx, and or unclassifiable lesion.
Indication for follow up.
- Newly detected or changing lesions without blue, grey or white colours.
- Patient < 45 with unknown history and unclassifiable lesion.
