Oral epithelial dysplasia and oral potentially malignant disorders Flashcards
oral cancer red flags
> 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
How to increase early detection?
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
oral cancer risk factors
smoking
poor oral hygiene
alcohol
HPV
chewing tobacco
low fruit/veg consumption
socio economic background
what is oral epithelial dysplasia?
abnormal growth
can only be diagnosed on histology
carried a higher risk of becoming cancer than ‘normal’ tissue
oral epithelial dysplasia - risk factors
smoking
alcohol
HPV
genetics?
Oral epithelial dysplasia - clinical presentation
in the mouth, patches may look red, white or a mixture of both
oral epithelial dysplasia - molecular markers
signalling pathways
cell cycle
apoptosis
COX 1 and 2 enzymes
proliferation and differentiation markers
viruses HPV + and HPV-
Loss of heterozygosity
EGFR
VEGF
telomerase
How to describe lesions
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
OED - molecular markers
signalling pathways
cell cycle
immortalisation
apoptosis
angiogenesis
COX1 and COX2 enzymes
viruses - hPV
basal hyperplasia features
increased basal cell numbers
architecture
- regular stratification
- basal compartment is larger
no cellular atypia
mild dysplasia features
moderate dysplasia features
severe dysplasia features
carcinoma in situ
theoretic concept
malignant but not invasive
abnormal architecture
- full thickness
pronounced cytological atypia
- mitotic abnormalities frequent
OED - management
mild
- monitor for at least 5 years
moderate or severe:
- considered for removal by oral and maxillofacial surgery
what is an oral potentially malignant disorder? define
any mucosal abnormality that is associated with statistically increased risk of developing oral cancer
OPMD’s examples
leukoplakia
proliferative verrucous leukoplakia
erythroplakia
oral sub mucous fibrosis
oral lichen planus
oral lichenoid lesion
actinic keratosis
palatal lesions in reverse smokers
oral lupus erythematous
dyskaratosis congenital
oral graft vs host disease
What is leukoplakia?
a descriptive term
predominately white patch not able to be attributed to another disorder (that does not have increased risk for cancer)
how might you describe leukoplakia?
homogenous leukoplakia
- typically well demarcated
non homogenous
- diffuse borders
- red/nodular components/textural/colour abnormalities
Leukoplakia - differential diagnosis
frictional keratosis
biting habits
Oral lichen Planus
pseudomembranous candidiasis
- can be scraped off
nicotinic stomatitis
papilloma
leukoedema
- bilateral, disappears on stretching
What is proliferative Verrucous Leukoplakia?
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
proliferative Verrucous Leukoplakia histology - early stage
broad expansion of rete processes
- flat/rounded ends resulting in elephant foot pattern with peaks of keratin forming in surface layer over connective tissue papillae
proliferative verrucous leukoplakia histology - late stage
acanthosis and well developed papillary architecture with lichenoid immune response
eyrthroplakia definition
predominantly fiery red patch that cannot be characterised clinically or pathologically as any other definable disease
erythroplakia features
solitary lesion, typically well demarcated
high risk of malignant change
solitary nature helps to distinguish from widespread conditions e.g. olp or blistering conditions
oral sub mucous fibrosis features
progressive
- loss of elasticity progresses to fibrosis of lamina propria
function limiting
may complain of burning to spicy food, later restricted mouth opening
linked to habits
- Paan, betel leaves etc
chronic hyperplastic candidiasis features and treatment
previously included OPMD
solely occurs in smokers
- will not resolve unless cessation occurs
systemic antifungal treatment
oral lichen planus malignant transformation risk
1% over 10 years
Oral Lichenoid lesions - risks of removing restorations
may be unrestorable
potential for tooth to become symptomatic
may require crown or larger restoration
may be no resolution
- can take up to 6-12 months to see improvement
Chronic hyperplastic candidosis features
solely occurs in smokers
- will not resolve unless cessation occurs
treat with systemic antifungals
white patch affecting buccal mucosa at labial commissure
