Oral epithelial dysplasia and oral potentially malignant disorders

Question 1

oral cancer red flags

Answer 1

> 3 week duration
50 years old
smoking
high alcohol consumption
history of oral cancer
non-homogenous
non-healing ulceration
non-healing ulceration (with o cause)
tooth mobility
non-healing extraction sockets
dysphagia
dysphonia
weight loss
numbness

Question 2

How to increase early detection?

Answer 2

soft tissue examination for patient every time
patient education and empowerment
recognition of complex social, cultural public health reasons behind risk behaviours, poor attendance and access to dental practices

Question 3

oral cancer risk factors

Answer 3

smoking
poor oral hygiene
alcohol
HPV
chewing tobacco
low fruit/veg consumption
socio economic background

Question 4

what is oral epithelial dysplasia?

Answer 4

abnormal growth
can only be diagnosed on histology
carried a higher risk of becoming cancer than ‘normal’ tissue

Question 5

oral epithelial dysplasia - risk factors

Answer 5

smoking
alcohol
HPV
genetics?

Question 6

Oral epithelial dysplasia - presentation

Answer 6

in the mouth, patches may look red, white or a mixture of both

Question 7

How to describe lesions

Answer 7

site
- higher risk sites incur ventrolateral tongue and floor of mouth
size
- larger lesions more concerning
colour
- red, white, mixed
texture
- when palpating - can you feel it? may feel thickened, rough, corrugated, firm, rubbery

Question 8

OED - molecular markers

Answer 8

signalling pathways
cell cycle
immortalisation
apoptosis
angiogenesis
COX1 and COX2 enzymes
viruses - hPV

Question 9

basal hyperplasia features

Answer 9

increased basal cell numbers
architecture
- regular stratification
- basal compartment is larger
no cellular atypia

Question 10

mild dysplasia features

Answer 10

architecture;
- changes in lower third
cytology:
- mild atypia

Question 11

moderate dysplasia features

Answer 11

architectural change extends into middle third
moderate atypical cells

Question 12

severe dysplasia features

Answer 12

architecture - changes extend to upper third
cytology; severe atypia and numerous mitoses, abnormally high

Question 13

carcinoma in situ

Answer 13

theoretic concept
malignant but not invasive
abnormal architecture
- full thickness
pronounced cytological atypia
- mitotic abnormalities frequent

Question 14

OED - management

Answer 14

mild
- monitor for at least 5 years
moderate or severe:
- considered for removal by oral and maxillofacial surgery

Question 15

what are oral potentially malignant disorders?

Answer 15

any mucosal abnormality that is associated with statistically increased risk of developing oral cancer

Question 16

OPMD’s examples

Answer 16

leukoplakia
proliferative verrucous leukoplakia
erythroplakia
oral sub mucous fibrosis
oral lichen plants
orla lichenoid lesion
actinic keratosis
palatal lesions in reverse smokers
opal lupus erythematous
dyskaratosis congenital
oral graft vs host disease

Question 17

What is leukoplakia?

Answer 17

a descriptive term
predominately white patch not able to be attributed to another disorder (that does not have increased risk for cancer)

Question 18

how might you describe leukoplakia?

Answer 18

homogenous leukoplakia
- typically well demarcated
non homogenous
- diffuse borders
- red/nodular components/textural/colour abnormalities

Question 19

Leukoplakia - what else could it be?

Answer 19

frictional keratosis
biting habits
Oral lichen Planus
pseudomembranous candidiasis
- can be scraped off
nicotinic stomatitis
papilloma
leukoedema
- bilateral, disappears on stretching

Question 20

What is proliferative Verrucous Leukoplakia?

Answer 20

a distinct form of multi-focal (arising from or present from more than one area) leukoplakia
highest risk of malignant change of all OPMDs
verroucous = verruciform = high risk words on biopsy reports

Question 21

proliferative Verrucous Leukoplakia histology - early stage

Answer 21

broad expansion of retention processes,