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oral pathology 2 > pigmented lesions > Flashcards

pigmented lesions Flashcards

1
Q

seborrheic keratosis occurs in the oral cavity?

A

NO

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2
Q

seborrheic keratosis

A

common skin lesion of older people

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3
Q

where is seborrheic keratosis found

A

face, trunk, extremities

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4
Q

if seborrheic keratosis was found in blacks, it’s called

A

dermatosis papulosa nigra (autosomal dominant)

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5
Q

common location of if seborrheic keratosis found in blacks

A

(dermatosis papulosa nigra)

-zygomatic and periorbital region

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6
Q

clinical features of seborrheic keratosis

A
  • well defined multiple plaques

- up to 2cm

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7
Q

what kind of appearance does seborrheic keratosis give?

A

stuck on skin appearance like puffy stickers

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8
Q

histopathology of seborrheic keratosis

A
  • exophytic proliferation of epithelium
  • horn cysts
  • basal cell layer shows pigmentation
  • squamous eddies
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9
Q

squamous eddies

A

whorls of squamous cells undergoing metaplasia

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10
Q

horn cysts

A

keratin filled invaginations

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11
Q

actinic lentigo

A

age spot
liver spot
solar lentigo

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12
Q

actinic lentigo=age spot=
liver spot=
solar lentigo

A

flat, brown macule on skin

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13
Q

actinic lentigo=age spot=
liver spot=
solar lentigo results from

A

chronic UV light exposure

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14
Q

actinic lentigo=age spot=
liver spot=
solar lentigo in oral cavity?

A

NO

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15
Q

actinic lentigo=age spot=
liver spot=
solar lentigo seen in what kind of patients

A

older

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16
Q

common location of actinic lentigo=age spot=
liver spot=
solar lentigo

A

hands + face

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17
Q

actinic lentigo=age spot=
liver spot=
solar lentigo undergoes malignant transformation?

A

NO

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18
Q

melasma

A

hyperpigmentation of face + neck

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19
Q

what is known as the mask of pregnancy?

A

melasma

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20
Q

melasma occurs in women

A

taking oral contraceptives

-pregnant

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21
Q

melasma develops from

A

sun exposure

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22
Q

melasma

A

bilateral brown or graish macules

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23
Q

melasma has a potential for malignant transformation?

A

no

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24
Q

melasmas may resolve when?

A

after birth or discontinuation of contraceptives

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25
Q

oral melanoacanthoma

A

reactive, asymptomatic lesion, occurs out of the blue

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26
Q

oral melanoacanthoma primarily seen in

A

black females

-acquired benign pigmentation

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27
Q

common site of oral melanoacanthoma

A

buccal mucosa

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28
Q

clinical features of oral melanoacanthoma

A

dark brown to black

  • smooth and flat , can be elevated
  • rapid increase in size (Few centimeters in few weeks)
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29
Q

**histopathology of oral melanoacanthoma

A

dendritic melanocytes throughout epithelium

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30
Q

oral melanoacanthoma tx

A

biopsy to r/o melanoma

-confirm diagnosis, not other treatment necessary

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31
Q

melanotic macule=

A

focal melanosis

-overproduced melanin

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32
Q

melanotic macule=focal melanosis

A

flat, brown discoloration

-increase in melanin deposition

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33
Q

melanotic macule=focal melanosis result of UV light exposure?

A

NO!

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34
Q

common location of melanotic macule=focal melanosis

A
  • lower lip near vermillion border
  • buccal mucosa
  • gingiva
  • palate
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35
Q

nevus (nevi)

A

1 intradermal/intramucosal nevus
2 junctional nevus
3 compound nevus
4 blue (dermal melanocytoma/jadassohn-Tieche nevus)

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36
Q

dermal melanocytoma/jadassohn-Tieche nevus

A

blue nevus

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37
Q

based on growth pattern, location + histopathology

A

1 intradermal/intramucosal
2 junctional
3 compound

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38
Q

intradermal nevus

A
  • occus on skin
  • slightly elevated and may be pigmented
  • can look like a papilloma
  • may have hairs growing from the center
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39
Q

intramucosal mevus

A
  • occurs on mucosal surfaces found in oral cavity

- may be elevated and pigmented

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40
Q

histopathology of intradermal/intramucosal nevus

A
  • theques

- nevus cells

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41
Q

nevus cells

A

ovoid cells w/ uniform nuclei that may produce pigment

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42
Q

theques

A

-collection of nevus cells within the CT or dermis layer

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43
Q

junctional nevus

A

nevus cells occur along basal cell layer

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44
Q

compound nevus

A

occur along basal cell layer and CT

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45
Q

junctional + compound nevi

A

theques

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46
Q

blue nevus

A

benign proliferation of dermal melanocytes

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47
Q

blue nevus is found on

A

face, scalp, hands, feet

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48
Q

blue nevus most common location intraorally

A

**hard palate

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49
Q

clinical features of blue nevus

A
  • macule or dome shaped

- blue or black in color

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50
Q

color of blue nevus comes from

A

tyndall effect

  • blue color has short wavelength that is reflected back
  • colors with longer wavelengths are absorbed by tissue
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51
Q

histopathology of nevus cells

A

elongated or spindle shaped in CT

-parallel to surface epithelium

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52
Q

treatment of bluenevus

A

surfical excision

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53
Q

blue nevus

A

deep within CT, pigmented cells

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54
Q

amalgam tattoo

A

discoloration of oral mucosa

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55
Q

amalgam tattoo results from

A
  • endodontic retrofill
  • pieces fall into extraction socket
  • fine particles from hi speed drill
  • flossing with a recent restoration
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56
Q

clinical features of amalgam tattoos

A
  • black, blue, or gray macule

- seen on gingiva, alveolar mucosa, or buccal mucosa

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57
Q

on radiographs,

A

radiopaque fragments small in size

58
Q

histopathology of amalgam tattoee

A

brown or black granules or chunks in CT

59
Q

treatment of amalgam tattoo

A

biopsy

-non if can see radiographically

60
Q

systemic metallic intoxication

A

lead (plumbism)

61
Q

lead (plumbism) [systemic metallic intoxication ] oral findings

A
  • blue line on gingiva (Burton line
  • gray areas on buccal mucosa and tongue
  • tongue thrusting
  • excessive salivation
  • metallic taste
  • advanced periodontal disease
62
Q

most widespread environmental toxin affecting children

A

lead (plumbism)

63
Q

where is lead (plumbism) found?

A

house paint
plumbing
gasoline, but removed

64
Q

diagnosis of lead (plumbism)

A

difficult

65
Q

acute form of lead (plumbism)

A

abdominal colic
encephalopathy
renal dysfunction

66
Q

chronic form of lead (plumbism) affects

A

nervous system
kidneys
bone + joints

67
Q

burton’s line

A
  • seen in lead (plumbism) [systemic metallic intoxication ]

- blue line on gingiva

68
Q

mercury( systemic metallic intoxication)

A

acrodynia/pink/swift disease

69
Q

acrodynia

A

pink disease=swift disease= mercury

70
Q

acute form of mercury= acrodynia/pink/swift disease( systemic metallic intoxication)

A 
abdominal pain
vomiting
diarrhea
pharyngitis
gingivitis
71
Q

chronic form of mercury intoxication= acrodynia/pink/swift disease( systemic metallic intoxication)

A

kids will have rash, adults will have neurological symptoms

72
Q

chronic form of mercury intoxication neurological symptoms=erethism

A

tremors, memory loss, delirium

73
Q

mad as a hatter

A

hat makers were exposed to mercury= acrodynia/pink/swift disease

74
Q

oral changes of = mercury intoxication= acrodynia/pink/swift disease

A
  • metallic taste
  • enlarged and inflamed salivary glands
  • gingiva can be bleu-gray-to black
  • destroy alveolar bone with loss of teeth
75
Q

acrodynia or pink or swift disease is chronic form in

A

infants and children

76
Q

acrodynia or pink or swift disease is chronic form in infants and children

A

erythematous + pruirtiic rash w/ desquamation of palms and soles

  • patches of hair pulled out
  • increased lacrimation, neurologic symptoms, hypertension
77
Q

acrodynia or pink or swift disease oral changes

A

excessive salivation
premature loss of teeth
bruxism
ulcerative gingivitis

78
Q

silver (argyria), a systemic metallic intoxication

A

-has antibacterial properties but not deemed safe and effective

79
Q

silver (argyria) acute toxicity

A

coma
pleural edema
hemolysis
bone marrow failure

80
Q

silver (argyria) chronic toxicity (Argyria) affects

A

-liver, spleen, GI tract, respiratory system

81
Q

silver (argyria) chronic toxicity (Argyria) color

A

diffuse graish discoloration on sun exposed areas

82
Q

silver (argyria) chronic toxicity (Argyria) 2 oral cavity presentations

A

slate- blue silver line on gingival margins (initial sign)

diffuse blue black discoloration on oral mucosa

83
Q

gold systemic metallic intoxication

A

does not present as discoloration in the oral cavity as it is for mercury, silver, or lead

84
Q

gold is used in

A

rheumatoid arthiritis

85
Q

gold systemic metallic intoxication most common clinical sign

A

dermatitis preceded by pruritis

86
Q

clinical features intraorally of gold systemic metallic intoxication

A
  • oral mucositis
  • affects buccal mucosa, lateral border of tongue, palate, pharynx
  • metallic taste precedes mucositis
87
Q

chrysiasis

A

seen in gold systemic metallic intoxication

88
Q

chrysiasis presentation

A

slate-blue discoloration of sun exposed skin

89
Q

bismuth systemic metallic intoxication

A

used in surgical pack and to help treat diarrhea or nausea

90
Q

systemic toxicity of bismuth leads to

A

confusion, encephalopathy, hepatorenal impairment

91
Q

chronic exposure to bismuth

A

diffuse blue-gray discoloration of skin, conjunctivae, oral cavity

92
Q

clinical features intraorally of bismuth

A
  • bluegray line along gingival margin
  • burning
  • ulceration
  • stomatitis
  • if chew tablets, black discoloration on filiform papillae
93
Q

arsenic systemic metallic intoxication

A

can kill people

94
Q

arsenic systemic metallic intoxication was used for people with

A

asthma and skin disorders

95
Q

arsenic systemic metallic intoxication can cause various cancers

A

skin, lungs, liver, kidney

96
Q

arterial occlusion with possibility of spontaneous amputation

A

arsenic systemic metallic intoxication

97
Q

common clinical features of arsenic systemic metallic intoxication

A
  • diffuse macular hyperpigmentation

- hyperkeratosis on palms of hands/ soles of feet like papilloma lefevre but those patients won’t salivate a lot

98
Q

oral findgins of arsenic systemic metallic intoxication

A
  • excessive salivation

- necrotizing ulcerative stomatitis

99
Q

drug related discolorations of oral mucosa

A
  • some meds stimulate melanin production while drug metabolites can cause discoloration
  • produce diffuse melanosis of skin + mucosal surfaces
  • monocycline
100
Q

monocycline

A

a derivative of tetracycline and used to combat acne can cause drug related discolorations of oral mucosa

101
Q

clinical features of drug related discolorations of oral mucosa

A

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
Q

antimalarials (drug related discolorations of oral mucosa)

A

blue black discoloration on hard palate

103
Q

meds for AIDS patients (drug related discolorations of oral mucosa)

A

diffuse brown melanosis on buccal mucosa and attached gingiva (may resemble physiologic pigmentation)

104
Q

melanotic neuroectodermal tumor of infancy

A

only affects infants

105
Q

melanotic neuroectodermal tumor of infancy

A

benign, rare pigmented lesion

106
Q

when is melanotic neuroectodermal tumor of infancy seen?

A

1st year of life

107
Q

where does melanotic neuroectodermal tumor of infancy originate?

A

neural crest

108
Q

frequent sites of melanotic neuroectodermal tumor of infancy

A

anterior maxilla with male predilection

109
Q

clinical features of melanotic neuroectodermal tumor of infancy

A
  • rapid, expanding mass
  • blue or black
  • destroys underlying bone
  • displaces teeth even though they aren’t erupted yet
110
Q

what is seen in the urine of those with melanotic neuroectodermal tumor of infancy

A

high urine levels of VMA (vanillylmandelic acid)

111
Q

treatment of melanotic neuroectodermal tumor of infancy

A

surgical removal

112
Q

smoker’s melanosis

A

oral pigmentation increased significantly in heavy smokers

113
Q

melanin pigmentation protective response not only to UV damage but

A

also harmful substances of tobacco smoke

114
Q

where is smoker’s melanosis pigmentation seen in cigarette smokers

A

anterior facial gingiva

115
Q

where is smoker’s melanosis pigmentation seen in pipe smokers

A

buccal mucosa and commisure

116
Q

where is smoker’s melanosis pigmentation seen in reverse smokers

A

lit end of cigarette in mouth- hard palate

117
Q

pigmentation of smoker’s melanosis increased during

A

first year of smoking and number of cigarettes smoked each day

118
Q

female hormones and smoking create a

A

synergistic effect on smoker’s melanosis

119
Q

treatment of smoker’s melanosis

A

cessation of smoking can cause discoloration to fade over 3 years

120
Q

peutz jegher’s syndrome

A

autosomal dominant

121
Q

clinical features of peutz jegher’s syndrome

A

freckle like lesions on hands, perioral skin, oral mucosa

122
Q

oral lesions of peutz jegher’s syndrome

A

rxtension of freckles-brown to blue gray macules seen on labial /buccal mucosa, tongue, vermillion zone

123
Q

clinical features of peutz jegher’s syndrome

A

intestinal obstruction + intestinal polpys+ develop gastrointestinal adenocarcinoma

124
Q

intestinal polps in peutz jegher’s syndrome

A
  • hamartomatous growths

- polyps are not premalignant

125
Q

tx of peutz jegher’s syndrome

A

monitor for tumors and intestinal obstruction

126
Q

melanoma

A
  • does not present with intestinal polyps

- maxillary gingiva hard palate

127
Q

melanoma

A

malignant lesion of melanocytes

128
Q

melanoma arises from

A

benign melanocytic lesion or de novo (Can rise out of the blue)

129
Q

melanoma found on

A

skin expecially extremities and head and neck region

130
Q

oral melanomas are

A

rare

131
Q

risk factors for melanoma

A

fair complexion

  • light colored hair and eyes
  • sunburn or freckle easily
  • history of melanoma (family or self)
132
Q

four variants of melanoma

A
  • superficial spreading
  • nodular
  • lentigo maligna
  • acral lentiginous (found in oral cavity)
133
Q

melanoma malignant spread in 2 directions

A

radial- spread in horizontal direction (left to right) of the epithelium
vertical (nodular)

134
Q

radial spread of melanoma

A

spread in horizontal direction (left to right) of the epithelium

135
Q

example of radial spread of melanoma

A

superficial spreading
acral lentiginous
lentigo maligna

136
Q

vertical spread of melanoma

A

invade into CT

137
Q

example of vertical spread of melanoma

A

nodular

138
Q

ABCDE system of melanoma

A 
Asymmetry
Border irregularity
Color
Diameter >6mm (pencil eraser)
Evolving
139
Q

melanoma most common location in oral cavity

A

maxilla

140
Q

oral melanomas

A

located on hard palate or maxillary gingiva

  • brown or black macule w/ irregular borders
  • diffuse spreading results in nodular appearance

oral pathology 2 (3 decks)

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