pigmented lesions Flashcards
1
Q
seborrheic keratosis occurs in the oral cavity?
A
NO
2
Q
seborrheic keratosis
A
common skin lesion of older people
3
Q
where is seborrheic keratosis found
A
face, trunk, extremities
4
Q
if seborrheic keratosis was found in blacks, it’s called
A
dermatosis papulosa nigra (autosomal dominant)
5
Q
common location of if seborrheic keratosis found in blacks
A
(dermatosis papulosa nigra)
-zygomatic and periorbital region
6
Q
clinical features of seborrheic keratosis
A
- well defined multiple plaques
- up to 2cm
7
Q
what kind of appearance does seborrheic keratosis give?
A
stuck on skin appearance like puffy stickers
8
Q
histopathology of seborrheic keratosis
A
- exophytic proliferation of epithelium
- horn cysts
- basal cell layer shows pigmentation
- squamous eddies
9
Q
squamous eddies
A
whorls of squamous cells undergoing metaplasia
10
Q
horn cysts
A
keratin filled invaginations
11
Q
actinic lentigo
A
age spot
liver spot
solar lentigo
12
Q
actinic lentigo=age spot=
liver spot=
solar lentigo
A
flat, brown macule on skin
13
Q
actinic lentigo=age spot=
liver spot=
solar lentigo results from
A
chronic UV light exposure
14
Q
actinic lentigo=age spot=
liver spot=
solar lentigo in oral cavity?
A
NO
15
Q
actinic lentigo=age spot=
liver spot=
solar lentigo seen in what kind of patients
A
older
16
Q
common location of actinic lentigo=age spot=
liver spot=
solar lentigo
A
hands + face
17
Q
actinic lentigo=age spot=
liver spot=
solar lentigo undergoes malignant transformation?
A
NO
18
Q
melasma
A
hyperpigmentation of face + neck
19
Q
what is known as the mask of pregnancy?
A
melasma
20
Q
melasma occurs in women
A
taking oral contraceptives
-pregnant
21
Q
melasma develops from
A
sun exposure
22
Q
melasma
A
bilateral brown or graish macules
23
Q
melasma has a potential for malignant transformation?
A
no
24
Q
melasmas may resolve when?
A
after birth or discontinuation of contraceptives
25
oral melanoacanthoma
reactive, asymptomatic lesion, occurs out of the blue
26
oral melanoacanthoma primarily seen in
black females
| -acquired benign pigmentation
27
common site of oral melanoacanthoma
buccal mucosa
28
clinical features of oral melanoacanthoma
dark brown to black
- smooth and flat , can be elevated
- rapid increase in size (Few centimeters in few weeks)
29
****histopathology of oral melanoacanthoma
dendritic melanocytes throughout epithelium
30
oral melanoacanthoma tx
biopsy to r/o melanoma
| -confirm diagnosis, not other treatment necessary
31
melanotic macule=
focal melanosis
| -overproduced melanin
32
melanotic macule=focal melanosis
flat, brown discoloration
| -increase in melanin deposition
33
melanotic macule=focal melanosis result of UV light exposure?
NO!
34
common location of melanotic macule=focal melanosis
- lower lip near vermillion border
- buccal mucosa
- gingiva
- palate
35
nevus (nevi)
1 intradermal/intramucosal nevus
2 junctional nevus
3 compound nevus
4 blue (dermal melanocytoma/jadassohn-Tieche nevus)
36
dermal melanocytoma/jadassohn-Tieche nevus
blue nevus
37
based on growth pattern, location + histopathology
1 intradermal/intramucosal
2 junctional
3 compound
38
intradermal nevus
- occus on skin
- slightly elevated and may be pigmented
- can look like a papilloma
- may have hairs growing from the center
39
intramucosal mevus
- occurs on mucosal surfaces found in oral cavity
| - may be elevated and pigmented
40
histopathology of intradermal/intramucosal nevus
- theques
| - nevus cells
41
nevus cells
ovoid cells w/ uniform nuclei that may produce pigment
42
theques
-collection of nevus cells within the CT or dermis layer
43
junctional nevus
nevus cells occur along basal cell layer
44
compound nevus
occur along basal cell layer and CT
45
junctional + compound nevi
theques
46
blue nevus
benign proliferation of dermal melanocytes
47
blue nevus is found on
face, scalp, hands, feet
48
blue nevus most common location intraorally
**hard palate
49
clinical features of blue nevus
- macule or dome shaped
| - blue or black in color
50
color of blue nevus comes from
tyndall effect
- blue color has short wavelength that is reflected back
- colors with longer wavelengths are absorbed by tissue
51
histopathology of nevus cells
elongated or spindle shaped in CT
| -parallel to surface epithelium
52
treatment of bluenevus
surfical excision
53
blue nevus
deep within CT, pigmented cells
54
amalgam tattoo
discoloration of oral mucosa
55
amalgam tattoo results from
- endodontic retrofill
- pieces fall into extraction socket
- fine particles from hi speed drill
- flossing with a recent restoration
56
clinical features of amalgam tattoos
- black, blue, or gray macule
| - seen on gingiva, alveolar mucosa, or buccal mucosa
57
on radiographs,
radiopaque fragments small in size
58
histopathology of amalgam tattoee
brown or black granules or chunks in CT
59
treatment of amalgam tattoo
biopsy
| -non if can see radiographically
60
systemic metallic intoxication
lead (plumbism)
61
lead (plumbism) [systemic metallic intoxication ] oral findings
- blue line on gingiva (Burton line
- gray areas on buccal mucosa and tongue
- tongue thrusting
- excessive salivation
- metallic taste
- advanced periodontal disease
62
most widespread environmental toxin affecting children
lead (plumbism)
63
where is lead (plumbism) found?
house paint
plumbing
gasoline, but removed
64
diagnosis of lead (plumbism)
difficult
65
acute form of lead (plumbism)
abdominal colic
encephalopathy
renal dysfunction
66
chronic form of lead (plumbism) affects
nervous system
kidneys
bone + joints
67
burton's line
- seen in lead (plumbism) [systemic metallic intoxication ]
| - blue line on gingiva
68
mercury( systemic metallic intoxication)
acrodynia/pink/swift disease
69
acrodynia
pink disease=swift disease= mercury
70
acute form of mercury= acrodynia/pink/swift disease( systemic metallic intoxication)
```
abdominal pain
vomiting
diarrhea
pharyngitis
gingivitis
```
71
chronic form of mercury intoxication= acrodynia/pink/swift disease( systemic metallic intoxication)
kids will have rash, adults will have neurological symptoms
72
chronic form of mercury intoxication neurological symptoms=erethism
tremors, memory loss, delirium
73
mad as a hatter
hat makers were exposed to mercury= acrodynia/pink/swift disease
74
oral changes of = mercury intoxication= acrodynia/pink/swift disease
- metallic taste
- enlarged and inflamed salivary glands
- gingiva can be bleu-gray-to black
- destroy alveolar bone with loss of teeth
75
acrodynia or pink or swift disease is chronic form in
infants and children
76
acrodynia or pink or swift disease is chronic form in infants and children
erythematous + pruirtiic rash w/ desquamation of palms and soles
- patches of hair pulled out
- increased lacrimation, neurologic symptoms, hypertension
77
acrodynia or pink or swift disease oral changes
excessive salivation
premature loss of teeth
bruxism
ulcerative gingivitis
78
silver (argyria), a systemic metallic intoxication
-has antibacterial properties but not deemed safe and effective
79
silver (argyria) acute toxicity
coma
pleural edema
hemolysis
bone marrow failure
80
silver (argyria) chronic toxicity (Argyria) affects
-liver, spleen, GI tract, respiratory system
81
silver (argyria) chronic toxicity (Argyria) color
diffuse graish discoloration on sun exposed areas
82
silver (argyria) chronic toxicity (Argyria) 2 oral cavity presentations
slate- blue silver line on gingival margins (initial sign)
| diffuse blue black discoloration on oral mucosa
83
gold systemic metallic intoxication
does not present as discoloration in the oral cavity as it is for mercury, silver, or lead
84
gold is used in
rheumatoid arthiritis
85
gold systemic metallic intoxication most common clinical sign
dermatitis preceded by pruritis
86
clinical features intraorally of gold systemic metallic intoxication
- oral mucositis
- affects buccal mucosa, lateral border of tongue, palate, pharynx
- metallic taste precedes mucositis
87
chrysiasis
seen in gold systemic metallic intoxication
88
chrysiasis presentation
slate-blue discoloration of sun exposed skin
89
bismuth systemic metallic intoxication
used in surgical pack and to help treat diarrhea or nausea
90
systemic toxicity of bismuth leads to
confusion, encephalopathy, hepatorenal impairment
91
chronic exposure to bismuth
diffuse blue-gray discoloration of skin, conjunctivae, oral cavity
92
clinical features intraorally of bismuth
- bluegray line along gingival margin
- burning
- ulceration
- stomatitis
- if chew tablets, black discoloration on filiform papillae
93
arsenic systemic metallic intoxication
can kill people
94
arsenic systemic metallic intoxication was used for people with
asthma and skin disorders
95
arsenic systemic metallic intoxication can cause various cancers
skin, lungs, liver, kidney
96
arterial occlusion with possibility of spontaneous amputation
arsenic systemic metallic intoxication
97
common clinical features of arsenic systemic metallic intoxication
- diffuse macular hyperpigmentation
| - hyperkeratosis on palms of hands/ soles of feet like papilloma lefevre but those patients won't salivate a lot
98
oral findgins of arsenic systemic metallic intoxication
- excessive salivation
| - necrotizing ulcerative stomatitis
99
drug related discolorations of oral mucosa
- some meds stimulate melanin production while drug metabolites can cause discoloration
- produce diffuse melanosis of skin + mucosal surfaces
- monocycline
100
monocycline
a derivative of tetracycline and used to combat acne can cause drug related discolorations of oral mucosa
101
clinical features of drug related discolorations of oral mucosa
bone is dark green
- oral mucosa appears blue-gray
- linear band of the gingiva near the mucogingival jxn
- broad discoloration on hard palate
- teeth may be darkly stained from affected dental pulp
102
antimalarials (drug related discolorations of oral mucosa)
blue black discoloration on hard palate
103
meds for AIDS patients (drug related discolorations of oral mucosa)
diffuse brown melanosis on buccal mucosa and attached gingiva (may resemble physiologic pigmentation)
104
melanotic neuroectodermal tumor of infancy
only affects infants
105
melanotic neuroectodermal tumor of infancy
benign, rare pigmented lesion
106
when is melanotic neuroectodermal tumor of infancy seen?
1st year of life
107
where does melanotic neuroectodermal tumor of infancy originate?
neural crest
108
frequent sites of melanotic neuroectodermal tumor of infancy
anterior maxilla with male predilection
109
clinical features of melanotic neuroectodermal tumor of infancy
- rapid, expanding mass
- blue or black
- destroys underlying bone
- displaces teeth even though they aren't erupted yet
110
what is seen in the urine of those with melanotic neuroectodermal tumor of infancy
high urine levels of VMA (vanillylmandelic acid)
111
treatment of melanotic neuroectodermal tumor of infancy
surgical removal
112
smoker's melanosis
oral pigmentation increased significantly in heavy smokers
113
melanin pigmentation protective response not only to UV damage but
also harmful substances of tobacco smoke
114
where is smoker's melanosis pigmentation seen in cigarette smokers
anterior facial gingiva
115
where is smoker's melanosis pigmentation seen in pipe smokers
buccal mucosa and commisure
116
where is smoker's melanosis pigmentation seen in reverse smokers
lit end of cigarette in mouth- hard palate
117
pigmentation of smoker's melanosis increased during
first year of smoking and number of cigarettes smoked each day
118
female hormones and smoking create a
synergistic effect on smoker's melanosis
119
treatment of smoker's melanosis
cessation of smoking can cause discoloration to fade over 3 years
120
peutz jegher's syndrome
autosomal dominant
121
clinical features of peutz jegher's syndrome
freckle like lesions on hands, perioral skin, oral mucosa
122
oral lesions of peutz jegher's syndrome
rxtension of freckles-brown to blue gray macules seen on labial /buccal mucosa, tongue, vermillion zone
123
clinical features of peutz jegher's syndrome
intestinal obstruction + intestinal polpys+ develop gastrointestinal adenocarcinoma
124
intestinal polps in peutz jegher's syndrome
- hamartomatous growths
| - polyps are not premalignant
125
tx of peutz jegher's syndrome
monitor for tumors and intestinal obstruction
126
melanoma
- does not present with intestinal polyps
| - maxillary gingiva hard palate
127
melanoma
malignant lesion of melanocytes
128
melanoma arises from
benign melanocytic lesion or de novo (Can rise out of the blue)
129
melanoma found on
skin expecially extremities and head and neck region
130
oral melanomas are
rare
131
risk factors for melanoma
fair complexion
- light colored hair and eyes
- sunburn or freckle easily
- history of melanoma (family or self)
132
four variants of melanoma
- superficial spreading
- nodular
- lentigo maligna
- acral lentiginous (found in oral cavity)
133
melanoma malignant spread in 2 directions
radial- spread in horizontal direction (left to right) of the epithelium
vertical (nodular)
134
radial spread of melanoma
spread in horizontal direction (left to right) of the epithelium
135
example of radial spread of melanoma
superficial spreading
acral lentiginous
lentigo maligna
136
vertical spread of melanoma
invade into CT
137
example of vertical spread of melanoma
nodular
138
ABCDE system of melanoma
```
Asymmetry
Border irregularity
Color
Diameter >6mm (pencil eraser)
Evolving
```
139
melanoma most common location in oral cavity
maxilla
140
oral melanomas
located on hard palate or maxillary gingiva
- brown or black macule w/ irregular borders
- diffuse spreading results in nodular appearance
