Oral mucosal colour changes Flashcards
1
Q
What are some reasons Oral white lesions can form?
A
- Hereditary
- Smoking/frictional
- Lichen Planus
- Lupus eryhtematosus
- GVHD
- Candidal leukoplakia
- Carcinoma
2
Q
How can candidal leukoplakia cause white lesions?
A
- Candida can cause inflammation in the epithelium and surrounding tissues
- Inflammation will allow fluid and thickness in the epithelium , reducing blood flow to epithelium , causing whiteness
3
Q
How does smoking/frictional cause oral white lesions?
A
- Cause irritation to mucosal surface
- Thicken keratin layer (acanthosis)
- Keratin layer obstructs blood flow to keratin layer causing whiteness
4
Q
How does a carcinoma cause oral white lesion?
A
- Associated with thickening of cells as they are proliferating at uncontrollable manor
- Acanthosis - whiteness
5
Q
Why are white lesions white?
A
- In normal mucosa lamina dura exists beneath spinosum and stratum cornea layer
- Cells become less dense as you move up to surface allows blood vessels to be seen
- In keratinsed tissues, the cells are denser as thickening of the mucosa or keratin occurs , tissue is less opaque therefore can’t see the blood vessels as clearly, showing whiteness instead
- Or shows white lesions as there is less blood in the tissues due to vasoconstrictors (blanching)
6
Q
What is meant by the term Leukoplakia?
A
- A white patch which cannot be scraped off or attributed to any other cause
- No histopatholgical connotation
- Does not mean malignant (around 1% in UK)
7
Q
What is shown in these pictures? Describe the condition
A
- Fordyce’s spots
- Ectopic sebaceous glands
- Mucosa forms from the skin therefore normal for sebaceous glands to be produced in mucosa
- Seen mostly on buccal mucosa and also can be seen on lips
8
Q
What does this picture show?
A
- Frictional keratosis
- Rubbing is causing the reactive thickening of the mucosa
- Keratotic thickening occurs meaning less opacity to blood vessels in lamina dura , there fore white appearance
9
Q
What does this picture show?
A
- Smoker’s keratosis
- Trauma from thermal gases
- Reactive change of keratin
- Thickening of keratin , less able to see BV so white appearance
10
Q
What does this picture show?
A
- The histology of Smoker’s/traumatic
- Shows thick layer of keratin formed on the palate
- Mucosa is normal
- Melanocytes have overproduced melanin commonly seen with trauma so see an increase in melanin pigment
11
Q
Does smokers keratosis increase chance of malignant risk?
A
- Smokers more likely to have leukoplakia
- Low malignant potential of the lesion
- BUT higher oral cancer risk due to smoking
12
Q
What does this picture show?
A
- White sponge naevus
- Hereditary keratosis
- Often starts in childhood and if one person in fam has it , likely others will to
13
Q
What does this image show?
A
- White sponge naevus wtih areas of spongiosis
- Spongiosis causing fluid filled areas within the epithelium
- Making it less opaque so can’t see the BV as clearly and lesion appears white
14
Q
Describe this white lesion
A
- White lesion on the maxillary tuberosity
- It has clear cut edge
- Appears thickened
- No erythema surrounding so inflammation has not occurred
- If lesion is malignant then will show inflammation surrounding the edge
- This lesion has no trauma related aspects therefore deemed Idiopathic keratosis
15
Q
What is this picture showing?
A
- Chemical (aspirin) burn
- Acidic substance held in contact with mucosa
- Caused coagulation of proteins and thickening of the mucosa
16
Q
What is this picture showing?
A
- Pseudomembranous acute candidosis (acute)
- Can be scraped of as not adherent to mucosa due to pseudomembranous
- Will leave inflammatory area underneath the lesion
17
Q
What is this picture showing?
A
- Denture associated erythemous candidosis (Chronic)
- Denture covered tissues are erythematous due to poor denture hygiene
18
Q
What are these pictures showing?
A
- Herpes simplex virus
- Gives intraepithelial vesicles that disrupt the view of the connective tissue blood vessels
- Once the vesicle bursts you lose the whiteness
19
Q
When do you refer a white lesion?
A
- Most are benign
- If red and white parts concentrate on red part
- If lesion is becoming more raised and thickened
- If lesion is whitou cause i.e. lateral tongue / anterior floor of mouth / soft palate area
20
Q
Why are red lesions red?
A
- Blood flow increases due to inflammation or dysplasia
- Or due to reduced thickness of epithelium which is making connective tissue redness more visible
21
Q
What does this picture show?
A
- ## Desquamative gingivitis due to thinning of epithelium
22
Q
What is Eruthroplakia?
A
- Area of redness which can’t be attributed to any other cause
- Higher concern than leukoplakia and require biopsy
23
Q
What are blue lesions?
A
- Due to fluid in the connective tissue
- Can be dark which show slow moving blood like varicosities - are going to be veins or cavernous haemangioma
- Can be light blue and contain clear fluid - most likely saliva (mucocele) or lymph (lymphangioma)
24
Q
What does this picture show?
A
- Vascular haemangioma
- Can be capillary or cavernous
25
What is this picture?
- Cavernous haemangioma
26
What is the difference between these two pics?
First one shows capillarious haemangioma - red lesion
Second one shows cavernous haemangioma - slow moving blood , rapid deoxygenation giving blue appearance (can see the larger areas)
27
What is a Lymphangioma?
- Takes lymph fluid from the tissues back into circulation
28
What are some exogenous causes mucosal pigementation?
- Tea , Coffee , Chlorhexidine
- Bacterial overgrowth
29
What are some intrinsic causes of mucosal pigmentation?
- Reactive melanosis/melanotic macule
- Melanocytic naevus
- Melanoma
- Effect of systemic disease, paraneoplastic phenomenon
30
What are some intrinsic foreign body cause of mucosal pigmentation?
- Amalgam, arsenic
31
What is a melanocytic naevus?
- Melanocyte is becoming abnormal and produces too much melanin (proliferation increases)
- Produces benign skin lesion
32
What is a melanotic macule?
- Normal amount of melanocytes with increased amount of melanin
- Benign mucosal pigmentation
33
What is a melanoma?
- Cancer producing pigment
34
What are the causes of brown or black lesions?
- Racial/familial
- Smoking
- Drugs like contraceptive pill or tetracyclines as this stimulates production of melanin by melanocytes
- Addisons disease caused by raised ACTH conditions so stim of melanocytes increases
35
What does this image show?
- Melanotic macule
36
What do these pictures show?
- Amalgam tattoo
- Metal is a foreign body and is being phagocytosed by giant cells to be removed in mucosa
- Dont take radiograph it is not justified, take biopsy
37
What disease do these pictures show
- Addisons / Cushing disease
- ACTH hormone is increased
- Increased ACTH increases melonocyte production of melanin
- Lead to pigmented mucosa
38
What are the characteristics of melanoma?
- Variable pigmentation within single lesion
- Irregular outline
- Raised surface
- Symptomatic - May itch or bleed
- Refer
39
Why are biopsys important?
- Identify or exclude malignancy
- Identify dysplasia
- identify other disease like LP
40
What is the general rule in regard to biopsy?
- Any white, red or pigmented patch that can't be explained must be biopsied
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