ORAL PATH white lesions Flashcards
what type of white lesion is a fordyce granule?
developmental - ectopic sebaceous glands
where do you commonly find fordyce granules?
lip and buccal mucosa
what is a risk factor for fordyce granules?
age
what type of white lesion is leukoedema?
normal variation - milky white colouration
what type of white lesions are white sponge naevus, pachyonychia congenita, and dyskeratosis congenita?
hereditary
what type of trauma can cause white lesions?
mechanical/ frictional
chemical
thermal
what type of white lesions are lichen plans and lupus erythematosus?
dermatological
what type of white lesions are candidosis, syphilitic leukoplakia, and oral hairy leukoplakia?
infective
what type of white lesions are leukoplakia and proliferative verrucous leukoplakia?
idiopathic
what type of white lesions are dysplastic lesions and SCCs?
neoplastic
describe white sponge naevus
ill-defined white patched with ‘shaggy’ surface
often bilateral
what areas can white sponge naevus affect?
any part of oral mucosa esp buccal mucosa
can also affect nose, oesophagus, and anogenital region
what causes white sponge naevus?
mutations in keratins 4 or 13
what is the treatment for white sponge naevus?
none required just explanation
what are the clinical features of oral hairy leukoplakia?
white, shaggy appearance on lateral tongue
asymptomatic
can affect other sites too
what is the cause of oral hairy leukoplakia?
EBV infection
also strongly associated with HIV infection
seen in immunocompromised and healthy pts
what is the treatment for oral hairy leukoplakia?
no treatment
describe frictional keratosis?
roughened white patch at site of chronic trauma
- hyperkeratosis
- prominent scarring fibrosis within submucosa
what is the treatment for frictional keratosis?
should resolve when source of friction is removed
what is lichen planus?
common chronic inflammatory disease of the skin and mucous membranes
what does lichen planus present with?
oral lesions in 50% of pts with skin lesions
buccal mucosa is most common site
describe LP skin lesions
violaceous itchy papule which may have distinctive white streaks on the surface (Wickham’s striae)
where is the most common site for LP skin lesions?
flexor surface of wrist
how long do LP lesions last?
skin lesions develop slowly and 85% resolve within 18 months
oral lesions run chronic course, sometimes several years.
describe LP oral lesions
spectrum of appearances
usually bilateral and often symmetrical
what is the aetiology of lichen planus?
unknown
chronic inflammatory disease of the skin and mucous membranes
what are the 6 difference appearances of LP?
reticular
atrophic
plaque-like
papular
erosive
bullous
describe reticular LP?
most common
lace-like striae
describe strophic LP
diffuse red lesions resembling erythroplakia
describe plaque-like LP
white plaques resembling leukoplakia
describe papular LP
small white papules which may coalesce
describe erosive LP
extensive areas of shallow ulceration
describe bullous LP
subepithelial bullae
why are clinical findings very important when you think you see LP?
the histopathology of lichenoid reaction is similar to lichen planus
what are LP histopathological features also seen in?
lichenoid reaction to drugs/ restorative materials
lupus erythematosus
graft vs host disease
lichenoid inflammation associated with dysplasia
what is treatment for lichen planus ?
if symptomatic, options include steroids
is lichen planus an oral potentially malignant disorder?
possible frequency of malignant change in LP is controversial but likely low
what is leukoplakia?
a clinical term used to describe a white plaque of questionable risk after having excluded other known diseases
is leukoplakia an OPMD?
risk of malignant transformation is low
what is proliferative verrucous leukoplakia?
a clinical pathological variant of oral leukoplakia
it is multifocal, persistent and progressive with a high rate of recurrence, and a high risk of progression to squamous cell carcinoma
what are risk factors of proliferative verrucous leukoplakia?
older pts
F>M
where would you find PVL?
gingiva
alveolar ridge
buccal mucosa
tongue
hard palate
if PVL turns into cancer, what is it called?
verrucous carcinoma or squamous cell carcinoma
what is the key histological feature of lichenoid inflammation/ lichen planus?
civatte bodies
what must you warn the patient when diagnosing lichen planus?
it is potentially malignant
