Oral Lesions + SSC Flashcards
Aphthous Stomatitis : population
25%
Females
Congenital
Aphthous Stomatitis : pathogenesis
UNCLEAR Immunodeficiency Decrease of mucosal barrier Genetic Antigenic exposure
Aphthous Stomatitis :
Associated conditions
Inflammatory Bowel Disease (chrohn’s)
Celiac disease
Betchet’s Syndrome (eye, genital)
SMOKING LOWERS
Aphthous Stomatitis:
Patho
Recurring, SUPER painful solitary/multiple ulcer
White-yellow pseudomembrane
Aphthous Stomatitis:
Variants?
Minor
Major
Herpetiform
Minor Aphthous Stomatitis:
Path
Well-circumscribed, superficial
<1cm
Labial / buccal mucosa, ventral tongue
Minor Aphthous Stomatitis:
Duration
10-14 days
No scarring
1-3 episodes/year
Major Aphthous Stomatitis:
Path
Onset after puberty
Lesions - larger,deeper, more
Tongue, soft palate, tonsillar fauces
Major Aphthous Stomatitis:
Duration
2-6 weeks
Heals w/ scarring
Herpetiform Aphthous Stomatitis:
Path
Onset - adulthood
Many lesions + recurrences
Small (1-3mm), coalesce
Any oral surface
Herpetiform Aphthous Stomatitis:
Duration
7-10 days
Aphthous Stomatitis :
DX
history, PE
Should resolve in 2 weeks, if no, biopsy
Aphthous Stomatitis:
Tx
SYMPTOMATIC Corticosteroids *Fluocinonide gel *Clobetasol propionate gel *Triamcinolone acetonide
Chlorhexidine Gluconate (peridex) mouthwash Amelexanox Paste (Aphthasol)
Aphthous Stomatitis:
pain relief
Viscous lidocaine OTC Benzacaine (oragel, anbesol) MOM antacid + diphenhydramine swish
Possible prednisone
Oral Herpes Simplex :
Etiology
15-45%
Primary infection in childhood
Most common site 2ndry Infxn - vermillion border/ perioral area (herpes labialis)
Acute Herpetic Gingiosomatitis:
Etiology
6 mos - 5 years
Peak 2-3 years old
Maternal antibodies younger than 6 mos
Acute Herpetic Gingivostomatitis:
Presentation
Abrubt onset Cervical lymph High fever Chills, nausea, anorexia Irritability
Acute Herpetic Gingivostomatitis:
Path
Lesion - vermillion border/lips to perioral area
Pinhead vesicles –> central ulcerations, erythema
Enlarged angry gingiva
Acute Herpetic Gingivostomatitis:
Adult presentation
Pharyngotonsillitis
(Vesicle - tonsil, post. Pharynx)
Resolve in 1-2 weeks
Oral Herpes Simplex:
Secondary/Recurrent Infection Triggers
UV, Trauma, Stress, Pregger
Herpes Labialis:
Path
6-24 hour prodrome
Rupture/Crust 1-2 days
Heal 7 - 10 days
Herpes Labialis:
Dx
History + P.E. Viral culture PCR Serology - 4-8 days Chronic? biopsy
Tzank prep
Herpes (multinucleated epithelial)
Varicella
Differential signs
Itching
All lesion phases
Herpes Zoster:
differential signs
Dermatome on 1 side
Older
Mononucleosis:
Differential signs
posterior tonsil exudate
Hand-and-Foot
(Coxsackie)
differential signs
Hands and feet
Younger
Herpes simplex:
Tx
SUPPORTIVE Viscous lidocaine NSAID Acyclovir (Zovirax) Valacyclovir (Valtrex), Famciclovir (Famvir) 1st infxn: acyc, valacy 2nd infxn: famcic, acyc Penciclovir cream
Oral Lichen Planus:
Dx. 5 Ps
Purple Pleuritic Planar Papular Plaque-like
If have Lichen planus, you should screen for
Hep C
Oral Lichen Planus:
Etiology
Women
30-60 y/o
Oral Lichen Planus:
Presentation
LESIONS - Multiple, bilateral, symmetrical
LOCATION - buccal mucosa, gingiva, tongue dorsum, labial mucosa, lower vermillion
Koebner Phenomenon
Oral Lichen Planus :
Presentation types
Reticular - white
Erythematous - Atrophic/ulcer
Erosive - bullous, ulcerated
Oral Lichen Planus:
Reticular lesions
Wickman’s Striae
Asymptomatic
Oral lichen planus :
Erythematous
Wickman’s Straie
Mucosal atrophy - red patch
Oral lichen planus:
Erosive
Desquamative gingivitis, frank ulcers, erosions
Bullae - easily rupture
Differential - white oral lesions
Candidiasis, leukoplakia, secondary syphilis, discoid lupus
Differential - Erythematous/Ulcerative lesions
Aphthous ulcers Discoid lupus Erythema multiforme Primary HSV stomatitis Oral SCC
Oral Lichen Planus:
Dx
Hx + PE
Bilateral whitman’s straie (one side- biopsy gingiva)
Oral Lichen Planus:
Tx
No cure Oral hygiene No tobacco/alcohol 1st line - topical corticosteroid *Clobetasol proprionate *Betamethasone proprionate
Oral Lichen Planus :
prognosis
Chronic, variable
No spontaneous remission
Post-inflame hyperpigmentation
Possible turn to SCC (6mos monitor)
Oral Lichenoid Drug Reacions (OLDR)
Less common than cutaneous Adults UNILATERAL NAKS (nsaids, ACEI, Ketoconazole, Sulfonylureas)
Leukoplakia :
Presentation
White patch, doesn’t scrape
Lip vermillion, buccal mucosa, gingiva
Early lesions - exophitic, gray/white
Homogenous/heterogeneous
Leukoplakia:
cancer?
Slower transform to SCC
Ventral tongue, oral floor
Female, non-smoker
5-25% - epithelial dysplasia
Leukoplakia:
Dx
Biopsy
Hyperkeratosis, acanthosis
Leukoplakia :
Tx
No dysplasia - monitor every 6 mos.
Moderate dysplasia - excision
Proliferative Verrucous Leukoplakia
DO NOT MISS DX
Female
Keratotic plaques, rough surface projection
60% to SCC w/in 7 yrs
Erythroplakia:
Etiology
Age 65-74
Erythroplakia:
Path
Mouth floor, ventral tongue, soft palate
Multiple lesions
Well-demarcated, red, asymptomatic, macule/plaque, soft velvety (no keratin)
Erythroplakia :
Dx
Biopsy
Erythroplakia :
Tx
Guide by degree of dysplasia
MODERATE - full excision
Follow-up : recurrence
Oral SCC :
Etiology
90% oral cancer
Male, >40, AA.
Tobacco use + heavy ETOH
UV/radiation, phenolic, Betal, Plummer Vinson, Vit A, 3 syphilis, HPV, immune
Oral SCC:
Path
Tongue, mouth floor, vermilion lip border
Oral cavity
Lips Buccal mucosa Front 2/3 of tongue Teeth Floor of mouth Hard palate Retro molar area
Oropharynx
Back 1/3 tongue
Soft palate
Tonsils+pillars
Throat Back wall
Oral SCC warning sign
LESION 2 WEEKS +
Pain, lump, ear pain, bleeding, bad breath
Lip Vermillion Carcinoma:
Etiology
Light-skin, sun
Lip Vermillion Carcinoma
Lower lip Crusted, nontender, oozing w/ ulcer <1cm Slow grower, late meta Submental nodes
Intraoral SCC :
Where
Tongue - post. Lat, ventral
Oral floor- from leuko/erythroplakia
Gingival - bone, tobacco, female
Posterior - advanced lesion
Intraoral SCC :
Presentation (lesions)
Most NO PAIN
Leuko/erythro/erythroleukoplakia
Exophytic/endophytic
Bone - moth bite, radiolucent
Intraoral SCC :
Dx
Biopsy
Scope 2nd cancer - larynx, lung, esophagus
Head/Neck - CT
Chest - CT/x-ray
Intraoral SCC :
Metastases
Ipsilateral cervical node
Oral floor –> submental
Lung, liver, bone
Carcinoma staging
TNM
T : tumor size (I, II, III, IV)
N: node
M: metastases
Intraoral SCC:
Tx
Guided by stage
Excision, radiation, chemo/radio
Intraoral SCC :
Prognosis
1/2 die w/in 5 yrs (BAD)
Survive 1st cancer - 20x for next
Early Dx + prevention