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5th Oral Disease -Histology Lectures > Pigemented Lesions > Flashcards

Pigemented Lesions Flashcards

1
Q

What are 4 main sources of pigment

A
  1. Melanin
  2. Haemosiderin
  3. Heavy metals
  4. Chromogenic bacteria
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2
Q

How is melanin produced?

A

Produced by melanocytes or nevus cells

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3
Q

What is a nevus cell?

A

Modified melanocyte found in moles of skin/ mouth

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4
Q

How do melanocytes produce and distribute melanin?

A

Has dendritic processes - distribute melanin to adjacent cells

Malansoma distributed to basal cells

Melanin transferred adjacent keratinocytes via membrane bond organelles = melanomas

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5
Q

When is increased melanin production worrying?

A

Increased production w/o increased number of melanocytes

Can only see melanocytes when abnormal change

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6
Q

What is haemosiderin?

A

Break down of RBCs

Haem component = iron stored
Iron can be stored as hemosiderin in cells

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7
Q

What heavy metals can cause pigmented lesions?

A

Bismuth, mercury, silver, arsenic, gold

Drugs w/ heavy metal e/g pepto-bismol

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8
Q

How does pepto-bismol cause heavy metal leaching?

A

Combined w/ sulphur in saliva = bismuth sulphide which is insoluble

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9
Q

Examples of occupational exposure to heavy metals?

A

Manufacture of ammunition, dental x-ray film

Lead miners, plumbers, mechanics, welding etc

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10
Q

What is argyria?

A

Exposure to excess silver

e.g colloidal silver ingestion

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11
Q

What are chromogenic bacteria?

A

Bacteria that produce pigement

Bacterial enzymes act on iron in saliva - produce salts = pigmentation

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12
Q

Give examples of chromogenic bacteria?

A

Aspergillus and actinomyces

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13
Q

What condition is often associated w/ chromogenic bacteria?

A

Hairy tongue

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14
Q

Difference between exogenous and endogenous lesions?

A

Exogenous - amalgam tattoo, foreign body tattoo, black hairy tongue

Endogenous - developmental, acquired and neoplastic

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15
Q

Examples of developmental pigmented lesions?

A

Physiological - melanin
Peutz Jehger’s syndrome
Haemochromatosis
Pigemented naevus - melanin

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16
Q

Examples of acquired pigmented lesions?

A 
Addison's disease
Drug induced
Post-inflammatory 
Smoker's melanosis 
Melanotic macule
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17
Q

Example of neoplastic lesions?

A

Melanoma

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18
Q

What info is needed to make differential diagnosis?

A 
Age
Occupation
Hx of lesion
MH, DH, DH, SH, FH
Extra and intra-oral examination
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19
Q

What is needed to diagnose an amalgam tattoo?

A

Silver/ grey often associated w/ adjacent tooth

Radiograph - can confirm amalgam

Biopsy - if lesion not classic

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20
Q

What to consider if amalgam tattoo in area with no tooth?

A

Associated tooth may have been XLA

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21
Q

Causes of amalgam tattoo?

A 
Low grade leaching 
Deep class II - amalgam pushed into PDL 
XLA - amalgam fall into XLA socket
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22
Q

What would histology of amalgam tattoo show?

A

Show black pigment in connective tissue

Amalgam runs along collagen fibres around blood vessels

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23
Q

How does histology of heavy metal lesions differ from amalgam tattoos?

A

Same histology

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24
Q

Who and where would you see black hairy tongue?

A

Posterior dorsum of tongue

Soft diet, smoking, ab use

25
How does black hairy tongue happen?
Decrease in normal desquamation process Elongated filiform papilla (white/brown/black) Discolouration by chromogenic bacteria, chlorhexidine, foods, smoking
26
Tx of black hairy tongue?
Reassurance Tongue scraper - reduce length filiform papillae Smoking cessation
27
What are physiological pigmented lesions?
See increased melanin in the gingiva | Normal physiological pigment - often present since birth
28
What is Peutz-Jeghers?
Autosomal dominant genetic disorder | See pigmented mucocutaenous macule, GI polyps, SI w/ increased risk of malignant change
29
How to melanotic spots appear in those w/ PJ?
Characteristically small and multiple Very obvious around lips Large pigmented freckles - skin and mucosal membrane
30
Why do those w/ suspected PJ need to be refereed early?
Increase risk of carcinoma
31
What histology would you see w/ PJ?
Increase melanin - see in basal cell layer excess melanin
32
What is haemochromatosis?
Autosomal recessive genetic disorder Causes accelerated rate of intestinal iron absorption = raised serum ferritin and transferrin saturation = accumulation of iron
33
What do you see in haemochromatosis
Bronze skin pigment
34
What population more likely to see hameochromatosis?
Celtic population
35
How to tx Haemochromatosis
Regular venesection - hard for body to excrete iron
36
What is melanin?
Synthesised by naevus cells derived from neural crest | Sound in skin and mucosa
37
What are histological types of naevus cells?
Junctional - epithelium Inderdermal/ mucosal - CT Compound - both
38
What is Addisons disease?
Autoimmune condition affecting adrenal gland = destruction of adrenal cortex
39
In Adddisons disease what does destruction of adrenal cortex cause?
Lack of adrenocortical hormone = increase ACTH produced by anterior pituitary
40
What does excess ACTH in Addisons disease cause?
ACTH induce melanocyte-stimulating hormones = pigmentation of skin and oral mucosa
41
What do you see in Addisons disease?
Diffuse brown patch on buccal mucosa, palate, tongue and gingivae Extra-oral: palmar creases
42
Histology of Addisons disease?
Increase melanin pigment in basal keratinocytes w/ no alteration to melanocytes
43
What are melanotic macule?
Can occur anywhere in mouth | Similar to those seen in PJ but not associated w/ syndrome
44
What would see in biopsy of melanotic macule?
Excess melanin in basal portion but no increase melanocytes
45
What drugs can cause pigmented lesions?
``` Antimalarial - chloroquine/ hydroxychloroquine Birth control pills Ketoconazole Tetracycline/ minocycline Doxorubicin (chemo-medication) ```
46
What do you see in drug induced pigmented lesions?
Increase production of melanin Deposition of iron after damage to mucosal vessel Deposition of heavy metal in skin
47
What are post-inflammatory pigmented lesions?
Usually people with darker skin Inflammatory insult = melanin accumulating Basal cell layer damage = melanin drop into lamina proprietary
48
Why can see post-inflammatory pigmented lesion in lichen planus?
Lymphocytes damage overlying mucosa | Melanocytes respond by producing melanin
49
What does smoking do to melanocytes?
Stimulate melanocytes = excess melanin
50
What is malignant melanoma?
Proliferation of malignant melanocytes along junction between epithelium and connective tissue and in CT
51
Where does malignant melanoma present orally?
Palate
52
Which gender does malignant melanoma affect more?
Men > women
53
How does malignant melanoma present?
Asymptomatic, slow growing black or brown patch w/ asymmetric and irregular borders Can be rapidly enlarging and associated w/ ulceration, bleeding, pain and bone destruction Can be non-pigmented
54
Tx of malignant melanoma?
Radical surgical excision w/ clean margins | Radiation and chemotherapy often ineffective
55
Problem w/ malignant melanoma?
5-year survival = 15% | Agressive and fatal
56
What is Kaposi sarcoma?
Malignant tumour Hallmark of AIDS Caused by HHV-8
57
How does Kaposi sarcoma present?
Black/ purple lesions orally | Gingivae commonly affected
58
Is Kaposi sarcoma a pigmented lesion?
Partially, haemosiderin gives brown colour | Vascularity gives red/blue colour
59
Tx of Kaposi sarcoma?
Excision +/- chemotherapy/ radiotherapy

5th Oral Disease -Histology Lectures (11 decks)

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