Oral Med Revision - Red & White Patches Flashcards
white v red patches
white = more keratin, hyperkeratosis
red = atrophy, hyperaemia or loss of keratinisation
why do oral lesions appear white
epithelium has thickened
organic material - candida infection, food debris
physiological - tongue coating, desquamation, leukoedema
causes -
CLINK
C - congenital
L - lichen planus
I - infections
N - neoplastic
K - keratosis
squamous cell carcinoma red flags
> 3wk duration
50yrs
smoking
high alcohol consumption
hx of oral cancer
non homogenous
non healing ulceration
induration
exophytic
tethering of tissue
tooth mobility
non healing xla sockets
difficulty speaking / swallowing
cervical lymphadenopathy
weight loss / appetite loss / fatigue
numbness / altered sensation
SCC mx
urgent suspected cancer referral to OMFS (not OM as this introduces delay)
follow local guidelines
honest with pt & explain concern
will need biopsy and will require this promptly
leukoplakia
a white patch that cannot be characterised clinically or pathologically
diagnosis of exclusion
cannot be rubbed away
homogenous leukoplakia = uniformly white, flat, thin, smooth surface, may exhibit shallow cracks
verrucous leukoplakia = surface raised, exophytic, wrinkled or corrugated
difficult to predict which will progress to cancer
risk factors for malignant transformation
larger size i.e. >200mm2, non homogenous, red or speckled, tongue & FoM, female, >50yrs, severe dysplasia
disorders that should be excluded for dx of leukoplakia
leukoedmea
white sponge naevus
frictional keratosis
chemical injury
acute pseudomembranous candidiasis
hairy leukoplakia
lichen planus
lichenoid reaction
discoid lupus erythematous
white patch general mx
dx through hx, exam, systems enquiry
exclude red flags
does it wipe away?
get photos
is there an obvious cause if so correct then rv
if no improvement or if unsure of dx refer
does this need biopsy for dx , exclusion
how often do i need to rv
why do lesions in mouth look red
inflammation
mucosal atrophy
increased vascularisation
mucosal / submucosal bleeding
diff dx of red patches
viral infection
candida
iatrogenic i.e. mucositis 2ndary to chemo/radio
LP
granulomatous dx
vesiculobullous dx
allergy
psoriasis
geographic tongue
leukaemia
trauma
deficiency
erythroplakia
erythroplakia
atrophic lesion
localised
well defined borders
velvety
can have speckled appearance (erythroleukoplakia)
fiery red patch that cannot be characterised clinically or pathologically as any other definable lesion
soft palate / buccal mucosa / FoM common
strong association with tobacco use
50% malignant transformation rate
may have p53 mutation
refer urgently to OMFS/OM
erythroleukoplakia
speckled white / red patches
heterogenous appearance
exists on spectrum with red / white patches
high suspicious for SCC / severe dysplasia
red patches mx
through hx & exam
exclude red flags
get photos
is there obvious cause? if so correct & rv
red patches or red speckled have high malignant potential
if cannot be attributed to another cause may require biopsy
