OM - Mucosal Colour Change Flashcards
What causes oral white lesions? (5)
- Hereditary
- Oral white sponge naevus
- Smoking/frictional
- Lichen planus
- Candidal leukoplakia
- Carcinoma
Describe why white lesions appear white. (2)
Red colour comes from the connective tissue where the vibrancy of the BV are diluted by the epithelial layers,
therefore if there is;
- Thickening of the mucosa or increased keratin deposition on the surface = less visibility of blood vessels in the CT beneath
- Less blood in the tissues (from vasoconstriction) = less visibility on the surface of the mucosa as blood flow is slowed
What is leukoplakia?
A white patch which cannot be scraped off or attributed to any other cause
No histopathological connotation - it is simply a clinical description not yet attributed to any other cause
Once biopsied and we have a diagnosis it is no longer a leukoplakia
How do we diagnose leukoplakia?
Via exclusion
What are fordyce spots?
ectopic sebaceous glands
Where are common sites for fordyce spots? (2)
Lips
Buccal mucosa
Do fordyce spots have malignant potential?
No
What is frictional keratosis?
Reactive thickening of the mucosa from a traumatic source – keratotic thickening leads to loss in visibility of blood vessels in CT
What is frictional keratosis usually associated with? (1)
an obvious traumatic source i.e. parafunctional clenching
What is smokers keratosis?
Trauma from thermal gases causes reactive keratotic changes and thickening of the mucosa leading to loss in visibility of blood vessels in CT.
Describe the appearance of smokers keratosis histologically.
Increased keratin deposition however the mucosa has no other changes except an increase in melanin pigment from the irritation (melanocytes over produce melanin)
Describe the malignant potential of smokers keratosis.
- Low malignant potential of the lesion but patient has a higher oral cancer risk in general
What is hereditary keratosis also known as?
White sponge naevus
What Is hereditary Keratosis (white sponge naevus)?
White appearance is from fluid accumulation (spongiosis) between the superficial layers of the epithelium. This increased the opacity of the tissues and reduces visibility of BV beneath.
How do we establish that the white lesion is hereditary keratosis and not frictional keratosis? (4)
lesions present in the sulcus - this area is hard to traumatise
Starts in
childhood and occurs initially in the posteriorly mouth
- Moves anteriorly and into the sulcus over time
Characteristically seen within multiple family members
What is idiopathic keratosis?
A biopsied Keratosis with a defined margin, a non-concerning appearance and with no obvious aetiological cause
What causes idiopathic keratosis?
When genetic programming within cells switches to overproduce keratin (more than what cells in this area would normally produce)
Describe hairy leukoplakia?
What causes this?
Elongation of the papillae on the tongue and thickening of the surface from the incorporation of the Epstein bar virus into the genetic code of the cells which causes them to reproduce at a faster rate and to reproduce with more keratin.
What drugs commonly cause chemical burns? (2)
Aspirin
Alandronic acid
Describe why herpes simplex creates a white lesion.
In the Primary form: Intraepithelial vesicles present which obscure visibility of blood vessels below and lesions appear white
- Lesion loses white appearance once vesicles burst
When should we refer a white lesion? (4)
If RED and WHITE concentrate on the RED part
If the lesion is becoming more raised and thickened
Inflammatory margin has become more pronounced (not a well-defined lesion with normal surrounding mucosa)
If the lesion is ‘without cause’ in;
Site - Lateral tongue
Site - Anterior floor of mouth
Site - Soft palate area
What causes the red appearance in erythroplakia? (2)
- Blood flow increases through the tissues from;
- Inflammation
- Dysplasia: causes increased vascularity
- Reduced thickness of the epithelium = CT redness more visible
What is erythroplakia?
Red patch which cannot be attributed to any other cause, atrophic or non-keratotic end of the spectrum
What lesions re more concerning? erythroplkia or leukoplakia?
Erythroplakia
list benign red lesions. (3)
geographic tongue
denture candidiasis
desquamative gingivitis
What causes a dark blue appearance of a lesion? give examples
Fluid in the connective tissue;
Dark = slow moving blood – from varicosities
e.g. Veins or cavernous haemangioma
Commonly seen under the tongue
What causes a light blue appearance of a lesion? give examples
- Fluid in the connective tissue;
Light Blue = clear fluid
e.g. eruption cysts, saliva (mucocele), Lymph (Lymphangioma
Name the 2 types of haemangioma (vascular harmatomas).
- Capillary
- Cavernous
Describe the difference between capillary and cavernous haemangiomas histologically.
Capillary
– lots of little blood vessels present
cavernous – large blood spaces
what is one way we can tell that a red/blue lesion is a haemangioma and not a malignant lesion?
Haemangioma Increases and reduces In size = vascular lesion (maliganacy only increases)
How do we distinguish between a lymphangioma and a cavernous haemangioma?
biopsy only - look similar clinically
List exogenous causes of pigmented lesions. (4)
- Tea, coffee, chlorhexidine
- Bacterial overgrowth
List intrinsic causes of pigmented lesions. (5)
- Reactive Melanosis (smoking) /melanotic macule (freckle)
- Melanocytic naevus
- Melanoma: cancer producing pigment (can be pigemtn free in the early stages)
- Effect of systemic disease, paraneoplastic phenomenon
- Intrinsic foreign body from Metals: amalgam, arsenic
Describe the difference between a melanotic macule and a melanotic naevus.
melanotic macule (freckle): normal no. of melanocytes producing an increased amount of melanin
Melanocytic naevus: increased number of melanocytes producing a normal amount of melanin
What are localised causes of brown/black lesions? (7)
Amalgam
melanotic macule
Melanotic naevus
Malignant Melanoma
Peutz-Jehger’s syndrome
Pigmentary incontinence
Kaposi’s sarcoma
What are generalised causes of brown/black lesions? (4)
Racial/familial/genetic
smoking
drugs
Addisons disease
Describe what causes amalgam localised intrinsic colour changes.
Amalgam is taken up and is phagocytosed by (giant) cells to be removed
What drugs can cause generalised brown/black pigmentation? (3)
- Contraceptive pill
- Tetracycline
- Newer biological drugs
Describe how Addisons disease can cause brown/black pigmentation. (2)
Addisons causes raised ACTH conditions
- ACTH includes part of the melanocyte stimulating hormone code = increased ACTH = increased melanin production by melanocytes
List the characteristic features of melanoma. (4)
- Variable pigmentation (high&low in same lesion)
- Irregular outline: has it grown in an expansive way?
- Raised surface: variable regions of thickness in the same lesion
- Symptomatic: Itch or bleed
What special investigation is used to exclude or identify melanoma?
biopsy
What should be referred to oral medicine? (3)
- Patients with abnormal and/or unexplained changes to the oral mucosa
- If there is concern about dysplasia risk - think;
- Appearance of lesion
- Risk site
- Risk behavior
- concerning Family history
What lesions should always be biopsied?
White, red or pigmented patches should always be biopsied if unexplained
Describe a non concerning leukoplakia.
Clearly defined white lesions
normal surrounding mucosa and with no inflammatory reaction around the borders
Describe a non concerning leukoplakia. (3)
Clearly defined white lesions
normal surrounding mucosa
no inflammatory reaction around the borders
