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4th year > OM- mucosal colour change > Flashcards

OM- mucosal colour change Flashcards

1
Q

What causes oral white lesions? (5)

A
  • Hereditary
  • Oral white sponge naevus
  • Smoking/frictional
  • Lichen planus
  • Candidal leukoplakia
  • Carcinoma
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2
Q

Describe why white lesions appear white. (2)

A

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
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3
Q

What is leukoplakia?

A

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

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4
Q

How do we diagnose leukoplakia?

A

Via exclusion

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5
Q

What are fordyce spots?

A

ectopic sebaceous glands

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6
Q

Where are common sites for fordyce spots? (2)

A

Lips
Buccal mucosa

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7
Q

Do fordyce spots have malignant potential?

A

No

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8
Q

What is frictional keratosis?

A

Reactive thickening of the mucosa from a traumatic source – keratotic thickening leads to loss in visibility of blood vessels in CT

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9
Q

What is frictional keratosis usually associated with? (1)

A

an obvious traumatic source i.e. parafunctional clenching

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10
Q

What is smokers keratosis?

A

Trauma from thermal gases causes reactive keratotic changes and thickening of the mucosa leading to loss in visibility of blood vessels in CT.

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11
Q

Describe the appearance of smokers keratosis histologically.

A

Increased keratin deposition however the mucosa has no other changes except an increase in melanin pigment from the irritation (melanocytes over produce melanin)

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12
Q

Describe the malignant potential of smokers keratosis.

A
  • Low malignant potential of the lesion but patient has a higher oral cancer risk in general
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13
Q

What is hereditary keratosis also known as?

A

White sponge naevus

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14
Q

What Is hereditary Keratosis (white sponge naevus)?

A

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.

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15
Q

How do we establish that the white lesion is hereditary keratosis and not frictional keratosis? (4)

A

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

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16
Q

What is idiopathic keratosis?

A

A biopsied Keratosis with a defined margin, a non-concerning appearance and with no obvious aetiological cause

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17
Q

What causes idiopathic keratosis?

A

When genetic programming within cells switches to overproduce keratin (more than what cells in this area would normally produce)

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18
Q

Describe hairy leukoplakia?
What causes this?

A

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.

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19
Q

What drugs commonly cause chemical burns? (2)

A

Aspirin
Alandronic acid

20
Q

Describe why herpes simplex creates a white lesion.

A

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

21
Q

When should we refer a white lesion? (4)

A

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

22
Q

What causes the red appearance in erythroplakia? (2)

A
  • Blood flow increases through the tissues from;
  • Inflammation
  • Dysplasia: causes increased vascularity
  • Reduced thickness of the epithelium = CT redness more visible
23
Q

What is erythroplakia?

A

Red patch which cannot be attributed to any other cause, atrophic or non-keratotic end of the spectrum

24
Q

What lesions re more concerning? erythroplkia or leukoplakia?

A

Erythroplakia

25
Q

list benign red lesions. (3)

A

geographic tongue
denture candidiasis
desquamative gingivitis

26
Q

What causes a dark blue appearance of a lesion? give examples

A

Fluid in the connective tissue;
Dark = slow moving blood – from varicosities
e.g. Veins or cavernous haemangioma
Commonly seen under the tongue

27
Q

What causes a light blue appearance of a lesion? give examples

A
  • Fluid in the connective tissue;
    Light Blue = clear fluid
    e.g. eruption cysts, saliva (mucocele), Lymph (Lymphangioma
28
Q

Name the 2 types of haemangioma (vascular harmatomas).

A
  • Capillary
  • Cavernous
29
Q

Describe the difference between capillary and cavernous haemangiomas histologically.

A

Capillary
– lots of little blood vessels present

cavernous – large blood spaces

30
Q

what is one way we can tell that a red/blue lesion is a haemangioma and not a malignant lesion?

A

Haemangioma Increases and reduces In size = vascular lesion (maliganacy only increases)

31
Q

How do we distinguish between a lymphangioma and a cavernous haemangioma?

A

biopsy only - look similar clinically

32
Q

List exogenous causes of pigmented lesions. (4)

A
  • Tea, coffee, chlorhexidine
  • Bacterial overgrowth
33
Q

List intrinsic causes of pigmented lesions. (5)

A
  • 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
34
Q

Describe the difference between a melanotic macule and a melanotic naevus.

A

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

35
Q

What are localised causes of brown/black lesions? (7)

A

Amalgam
melanotic macule
Melanotic naevus
Malignant Melanoma
Peutz-Jehger’s syndrome
Pigmentary incontinence
Kaposi’s sarcoma

36
Q

What are generalised causes of brown/black lesions? (4)

A

Racial/familial/genetic
smoking
drugs
Addisons disease

37
Q

Describe what causes amalgam localised intrinsic colour changes.

A

Amalgam is taken up and is phagocytosed by (giant) cells to be removed

38
Q

What drugs can cause generalised brown/black pigmentation? (3)

A
  • Contraceptive pill
  • Tetracycline
  • Newer biological drugs
39
Q

Describe how Addisons disease can cause brown/black pigmentation. (2)

A

Addisons causes raised ACTH conditions

  • ACTH includes part of the melanocyte stimulating hormone code = increased ACTH = increased melanin production by melanocytes
40
Q

List the characteristic features of melanoma. (4)

A
  • 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
41
Q

What special investigation is used to exclude or identify melanoma?

A

biopsy

42
Q

What should be referred to oral medicine? (3)

A
  • 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
43
Q

What lesions should always be biopsied?

A

White, red or pigmented patches should always be biopsied if unexplained

44
Q

Describe a non concerning leukoplakia.

A

Clearly defined white lesions
normal surrounding mucosa and with no inflammatory reaction around the borders

45
Q

Describe a non concerning leukoplakia. (3)

A

Clearly defined white lesions

normal surrounding mucosa

no inflammatory reaction around the borders

4th year (51 decks)

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