Other mucosal colour changes Flashcards
1
Q
What is erythematous candiosis
A
aka atrophic candidosis
appears red/raw
2
Q
What are the most common causes of erythematous candidosis
A
- denture induced
- antibiotic induced
- steroid induced
3
Q
What is acute erythematous candidosis commonly associated with
A
AB/steroid
4
Q
What is chronic erythematous candidosis commonly associated with
A
dentures
5
Q
What is angular cheilitis
A
inflammation typically seen at the angles (commissures of the lip)
usually caused by candida
6
Q
What are predisposing factors to angular cheilitis
A
- denture wearing
- deficiency states
- reduced OVD - lip anatomy
7
Q
What species is angular cheilitis usually associated with
denture related
A
candida
8
Q
What species is angular cheilitis usually associated with when not denture related
A
streptococci
staphylococci
9
Q
What is the treatment for angular cheilitis
A
- miconazole cream 2%
- 20g tube
- apply to angles of the mouth twice daily
10
Q
When should sodium fusidate ointment be used for angular cheilitis
A
- if patient is on warfarin/statin
- clearly bacterial cause
11
Q
What is the difference between a cream and an ointment
A
- cream is used on wet surfaces
- ointment is used on dry
12
Q
If angular cheilitis is not responding to first line tx, what should be given
A
miconazole + hydrocortison cream/ointment
13
Q
What are possible differntial diagnosis for dark blue lesions
A
likely due to slow moving blood
often haemangioa (cavernous)
14
Q
What are possible differential diagnosis for light blue lesions
A
saliva (mucocele)
lymph (lymphangioma)
15
Q
What is a hamartoma
A
Benign growth made up of an abnormal mix of cells and tissues normally found in that area
16
Q
What is a haemangioma
A
- type of hamartoma
- vascular malformation
17
Q
What is a capillary haemangioma
A
Made up of small capillaries that are normal in size but high in number
18
Q
What is a capillary haemangioma
A
Made up of small capillaries that are normal in size but high in number
19
Q
What is a cavernous haemangioma
A
- made of larger blood vessel that is dilated
20
Q
Where are haemangiomas common
A
tongue
vermillion border
buccal mucosa
21
Q
What is a lymphangioma
A
- type of hamartoma
- benign neoplasm of lymphatic channels
22
Q
What are the types of lymphangioma
A
- cavernous (most common on tongue)
- cystic hygroma
23
Q
What are the different vasculitic disease
A
- large vessel disease
- medium vessel disease
- small vessel disease
24
Q
What is an example of large vessel disease
A
giant cell (temporal) arteritis
25
What are examples of medium vessel disease
polyarteritis nodosa
kawasaki disease
26
What is an example of small vessel disease
granulomatosis with polyangitis
27
What are the broad 3 causes of mucosal pigmentation
* exogenous staining
* intrinsic pigmentation
* intrinsic foreign body
28
What can cause exogenous stain
tea, coffee, CHX
bacterial overgrowth
29
What are causes of intrinsic pigmentation
* reactive melanosis
* melanotic manule
* melanoma
* effect of systemic disease
* paraneoplastic phenomenon
30
What are examples of intrinsic foreign body
metals eg. amalgam/arsenic
31
What are causes of localised brown/black lesions
* amalgam
* melanocytic macule
* melanotic naevus
* malignant melanoma
* peutz-jehger's syndrome
* pigmentary incontinence
* kaposi's sarcoma
32
What are causes of generalised black/brown lesions
* racial pigment
* smoking
* drugs e.g OCP / tetracycline
* addison's disease (raised ACTH conditions = more melanocyte stimulation)
33
How does amalgam tattoo occur
macrophages (giant cells) try to phagocytose the amalgam unsuccessfully
the cells move elsewehere and spread out over time
34
When should mucosal pigmentation be referred
* if it is not easily explained
* if it is increasing in size, colour, quantity
* if there is any new sysetmic problems
35
What are the signs of a melanoma
* variable pigmentation
* irregular outline
* raised surface
* symptomatic - itch and bleed
36
Why is biopsy important
identifies or excludes malignancy
identifies dysplasia
identifies other disease e.g lichen planus
37
When should a white/red/pigmented patch be biopsied
if unexplained
38
When should a white/red/pigmented patch be biopsied
if unexplained
39
What should be referred to oral medicine
* patients with abnormal or unexplained changes to oral mucosa
* if there is concern about dysplasia risk
40
What can make a practitioner concerned about dysplasia risk
* appearance of lesion
* risk site
* risk behaviour
* family history e.g oral cancer history
41
What should not be referred to oral medicine
* asymptomatic variations of normal mucosa
* benign conditions the practitioner has diagnosed that are asymptomatic, do not have potentially malignant risk, no tx available
* if unsure consider photography and monitor area until next check up + send for specialist opinion if required
42
How can the differential diagnosis for red lesions be remembered
BLING
blood disorders
lichen planus/lupus erythematous
infection/inflammation
neoplasm/preneoplastic
geographic tongue
43
What is the most concerning red lesion
erythroplakia
44
What type of lichen planus causes red lesions
atrophic
45
What are examples of red neoplasms
peripheral giant cell tumour
angiosarcoma e.g kaposi sarcoma (linked to HIV/AIDS)
squamous cell
lymphoma
46
What is the other name for geographic tongue
erythema migrans
47
How does geographic tongue appear
* discount prominent red lesion on the dorsum of the tongue
* common cause of a sore tongue
48
What is the clinical appearance of geographic tongue
* irregular red depapillatde map like areas
* may be surrounded by a thicker yellow border
* increased thickness of the intervening filiform papillae
49
What investigations may we want to do for red lesions
biopsy
fbc
serum ferritin, b12, folate
swab
50
What are the most common vascular anomalies
varices
haemangioma
lympangioma
51
What are varices
dilated lingual veins
52
Where are the common areas for hamangioma
tongue
vermillion border
buccal mucosa
53
What are causes of extrinsicly discoloured pigmented lesions
food/drink
drugs
tobacco
54
What are causes of intrinsic pigmented lesions
phsyiological
melanotic macule
melanocytic naeuvus
melanoma
55
What is a melanotic macule
* single, brown, collection of melanin containing cells
56
What is the clinical presentation of melanotic macule
<1cm and flat
contain increased melanin
looks like a freckle
painless
seen commonly in vermillion border and palate
57
What is melanocytic naeuvus
blue/black lesions
Benign proliferation of the nevus cells (melanocytes)
uniform colour and borders
don't change in size or surface texture
58
What is the clinical presentation of melanocytic naevus
* usually <1cm
* painless
* generally dont change in size
* particularly seen on the palate
59
What are the clinical features of mucosal melanoma
* rare
* may arise in normal mucosa or in a pre-existing nauvus
* usually in palate/maxillary gingivae
60
What are the red flag features for pigmented lesion that point towards melanoma
* rapid increase in size
* change in colour
* ulceration
* pain
* lymph node enlargement
61
What is an amalgam tattoo
* localised blue/black lesion
62
What causes amalgam tattoo
* due to introduction of amalgam into soft tissues during dental procedures
63
What dental procedures may result in amalgam entering the soft tissue
* placement, removal or polishing of rest
* XLA - amalgam falling into socket
* retrograde filling of a root canal after apicectomy
64
If a diagnosis of amalgam tattoo cannot be made definitively, what should be done to disclude melanoma
biopsy
65
What happens on a histopathological level in amalgam tattoo
* macrophages/giant cells attempt to phagocytose the foreign body with little success
* can see multiple black deposits in the slides
* foreign material elicits a foreign bdoy reaction including lymphocytes and giant cells
66
What is kaposi sarcoma
type of cancer
can occur on skin, lymph nodes, mouth and other organs
67
What is the main cause of kaposi sarcoma
immunosuppression e.g HIV/AIDs + infection by HHV8
68
What is the appearance of kaposi sarcoma
red/blue or purple macular/nodular lesion
size ranges from small to extensive
diagnosis made via histopathology
69
What is a macule
flat, non-palpable lesion usually <10mm in diameter e.g freckle
70
What is a papule
* elevated lesion
* usually <10mm
* can be felt by palpation
* e.g papular lichen planus
71
What are plaques
* palpable lesions >10mm in diameter
* elevated/depressed compare to surface
72
What are causes of generalized pigmentation
* smoking
* hypoadrenalism
* drugs
73
What is the differential diagnosis for a localised pigmented lesion
* melanotic macule
* melanocytic naevus
* melanoma
* amalgam tattoo
* kaposi sarcoma
74
How does smoking result in generalised pigmentation
has an effect on the melanocytes
called smoker's melanosis
75
How does hypoadrenalism result in generalised pigmentation
adrenal gland is impacted and so there is reduced production of aldosterone and cortisol
reduced production causes negative feedback system to produce more ACTH
ACTH mimics MSH and results in increased melanin production
76
What is the cortisol production pathway
hypothalamus produces corticotrophic releasing hormone which acts on anteriro pituitary gland to produce adrenocorticotrophic hormone and this hormone acts on adrenal cortex
77
What drugs can result in generalised pigmentation
OCP - oestrogen and progesterone can effect melanocytes
tetracycline
antimilarials
acth therapy
78
What are the 3 categories of endogenous pathological pigmentation
melanin
blood derived pigments e.g haemosiderin
lipofuscin
79
What are melanophages
macrophages that have phagocytoses pigment
often seen in the lamina proprietor as they have phagocytosed pigment derived from the epithelium
80
Where are melanocytes naturally located
basal cell layer of the epithelium
81
What is secondary melanosis
aka reactive melanosis
when pigmentation is associated with abnormal epithelium
most frequent reason is due to smoking
82
How do melanocytes appear on histological slides
rounded
paler stained nuclei
these cells are not normally pigmented
the melanin they produce gets injected into the adjacent keratinocytes
