OPMDS Flashcards
What happens in pre-potentially malignant stage of oral carcinogenesis?
certain factors cause override of normal cell controls, causing:
overactivity of stem cells
keratinocyte stem cells turn into tumour initiating stem cells
dysregulation of cell proliferation, causing unrestricted growth
2 broad classifications of OPMDs
discrete mucosal lesions - morphologically altered tissue in which cancer is more likley to occur than its normal counterparts e,g, leukiplakia is most common DML
widespread conditions - a generalised state associated with signficantly increased risk of cancer (e.g. immunosuppression - genetic predisposition, HIV, immunosuppressant drugs)
Leukoplakia
Irremovable (by w
Leukoplakia
White patch which cannot be wiped off mucosa or ascribed to any other clinical or histopathological condition
has a potentially malignant predisposition
dx by ruling out other conditions
Proliferative verrucous leukoplakia.
Appearance (3), Where in oral cavity (3), Malignant transformation rate, Diff dx, etiology
wart-like, exophytic, fissured growth
gingiva, alveolar and buccal mucosa
70%
frictional hyperkeratosis
etiology NOT associated with tobacco or alcohol use
Erythroplakia.
appearance (3), common location (1), signifcance/danger! (1)
well defined, velvety red, depressed patch
FOM
40% already invasive SCC
Erythroleukoplakia
Appearance, diff dx
white speckles or nodules on atrophic erythematous base
chronic hyperplastic candidosis
4 main discrete oral lesions which are OPMDs
leukoplakia
erythroplakia
erythropleukoplakia
proliferative verrucous leukoplakia
Chronic hyperplastic candidiasis,
Why dont topical antifungals work for it? What to do instead?
Why might it recur after tx?
potentially malignant or not?
topical cream cannot penetrate thick, hyperplastic layer of keratin through to candida, need systemic antifungals e.g. Fluconazole 500mg daily AND BIOPSY
if pt smoker it may recur
YES opmd
Lichen Planus
Presentation (3) Which presentation is not concerning? (3) Which presentation is concerning and why? (3)
lace-like white patterns, can be mixed with hyperkeratosis, can present with erosions and atrophy
classic bilateral mucocutaneous presentation of LP not very concernign
isolated lichenoid lesions, especially on TONGUE –> very high risk of malignant change
What is overall rate of malignant transformation of oral epithelial dysplasia?
12.3%
highest risk areas of mouth for malignant transformation (3)
FOM
ventro-lateral surface of tongue
retromolar region
Which OPMDs have highest risk of malignant change
erythroplakia
erythroleukoplakia
nodular (non-homogenous) leukoplakia
Management goals when identifying a lesion that is suspicious
- Accurate diagnosis
- prediction of clinical behaviour
- Early recognition of malignancy
- Removal of dysplastic mucosa
- Prevention of recurrence
- Prevent malignant transofrmation
- Minimal pt morbidity
Surgical approaches to manage OPMDS? What NOT to do
surgical excision
photodynamic therapy
CO2 laser surgery
DO NOT DO cryotherapy
characteristics of HIGHEST RISK OF MALIGNANT CHANGE OPMDs (types of lesions, areas, pt incidence factors, size etc)
female, older age, NON-smokers
large size
high grade dysplasia
erythroplakia, erythroleukoplakia and nodular (non-homogenous) leukoplakia
FOM, ventro-lateral tongue, retromolar regions
