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Oral Path 1 > Pigmented Lesions > Flashcards

Pigmented Lesions Flashcards

1
Q

What gives lesions color?

A
  • Blood
  • Melanin
  • Foreign material
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2
Q

Hemangioma

A
  • Tumor of infancy that has rapid growth and endothelial cell proliferation
  • Not present @ birth - first 8 wks of life
  • Rapid growth phase followed by gradual involution
  • Most common
  • 60% in head/neck, more in females
  • Tx: N/A, they regress on their own. Systemic corticosteroids may help reduce size
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3
Q

Vascular Malformation

A
  • Anomalies of BV’s w/o endothelial proliferation
  • Present @ birth & persists through life
  • Tx:
    • Small lesion: N/A
    • Large lesion: Sclerosing agent and resection
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4
Q

Sturge-Weber Angiomatosis

A
  • Vascular proliferation involving tissues of brain and face
  • Non-hereditary developmental condition
  • Vascular malformation of the face = port wine stain
    • Unilateral distribution along one or more segments of trigeminal nerve
  • Leptomeningeal angiomas on ipsilateral cerebral cortex may cause convulsive disorder or mental retardation
  • Tx:
    • Flash lamp pulsed dye laser can improve esthetics
    • Mental complications/epilepsy may need neurosurgical tx
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5
Q

Varix

A
  • Abnormally dilated & tortuous veins
  • Common in older adults
    • Loss of CT tone supporting vessels
  • Usually blanche, but not if thrombus
  • Common location: sublingual varix
  • Tx: N/A; removed for esthetics
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6
Q

Kaposi’s Sarcoma

A
  • Vascular neoplasm caused by HHV-8
  • Associated w/ HIV
  • Painless blue-purple macules/plaques on surface of the skin
  • Oral lesions generally occur on the palate
  • Tx: Chemo or radiation
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7
Q

Sarcoma vs. Carcinoma

A

Sarcoma: Mesenchymal tissue so BVs, nn, salivary glands

Carcinoma: Epithelial derived

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8
Q

Petechiae

A

Small hemorrhages into skin, mucosa, serosa

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9
Q

Ecchymosis

A

Blood accumulation >2cm

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10
Q

Hematoma

A

Accumulation produces a mass

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11
Q

Ephelis (Freckle)

A
  • Represent region of increased melanin production
  • Face, arms, back of fair-skinned, blue-eyed, red or blond hair
  • Melanocortin-1-receptor gene (MC1R)
  • More pronounced after skin exposure
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12
Q

Oral Melanocytic Macule

A
  • Brown, mucosal discoloration due to increased melanin production
  • Flat
  • Not related to sun exposure
  • Vermillion border of lower lip (33%), buccal mucosa, gingiva, palate
  • Typically solitary (83%), well-defined, round/oval, <7cm
  • No premalignant potential
  • Management
    • Small, unchanging non-thickened lesions uniform in color w/ regular borders can be followed
    • Indications to biopsy a suspected melanotic macule
      • Recent onset, recent enlargement, or unknown duration
      • Raised
      • Large size
      • Irregular pigmentation
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13
Q

Melanoacanthoma

A
  • Reactive process
  • Almost exclusive to AA, mostly 3rd & 4th degrades
  • Buccal mucosa most common
  • Usually solitary, but occasionally bilateral or multifocal
  • Typically asymptomatic, smooth, flat, dark-brown to black
  • Often demonstrate rapid growth, reaching several cm in a few wks
  • Management: Biopsy to rule out melanoma
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14
Q

Nevus (Acquired Melanotic Nevus)

A
  • Malformation of the skin and mucosa
  • Proliferation of nevus cells, which are derived from neural crest
  • Develop during childhood and more are present before 35yo
  • Men and women, more in whites, above the waist
  • Management:
    • May be flat early in development, but eventually raised/thickened
    • Oral nevus is considered premalignant & should be completely excised
    • Melanoma cannot always be distinguished from nevus on a clinical basis
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15
Q

Blue Nevus

A
  • Proliferation of melanocytes deep in CT
  • Second most common nevus in the mouth
  • Seen almost always in the palate
  • Children & young adults, female predilection
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16
Q

Melanoma

A
  • Damage from UV radiation is a major causative factor
  • 3rd most common skin cancer
    • # 1 - basal cell carcinoma
    • # 2 - squamous cell carcinoma
  • Most cases seen in white adults (avg age 50-55yr)
    • Acute sun exposure (sunburn) may be of greater importance than chronic
  • Risk factors
  • Fair complexion and light hair
  • Burns easily
  • Indoor occupation w/ outdoor recreational habits
  • Personal/family h/o melanoma
  • H/o dysplastic or congenital nevus
17
Q

4 Clinicopathologic Types of Melanoma

A
  • Superficial spreading melanoma
  • Nodular melanoma
  • Lentigo maligna melanoma
  • Acral (mucosal) lentiginous melanoma
18
Q

Superficial spreading melanoma

A
  • Most common type of melanoma. Accounts for increased incidence of melanoma
  • Associated w/ acute & chronic sun exposure
  • Can occur in young adults
  • Can remain in radial growth phase for years
    • Nicest, spreads along the surface instead of invading
19
Q

Nodular Melanoma

A
  • Appears as a dome-shaped, darkly pigmented nodule
  • Grows rapidly
  • Exists in the vertical growth phase from the beginning, thus tends to be deeply invasive
20
Q

Lentigo Maligna Melanoma

A
  • Associated w/ chronic sun exposure
  • Occurs most commonly on the face of older adults
  • One or more darkly pigmented nodules arising in a solar lentigo
  • The most slow growing melanoma - may remain in radial growth phase for years
  • Solar lentigo: Brown (non-thickened) macule, larger than a freckle
    • Occurs on chronically sun-exposed skin, esp cheeks and dorsal surface of hands
    • Constant pigmentation
21
Q

Acral (mucosal) Lentiginous Melanoma

A
  • Most common form in the oral cavity
  • Melanomas of oral mucosa, palms, soles, nail beds
  • Most common in AA
22
Q

Oral Melanoma

A
  • Patients 6th-7th decades
  • 66% men
  • 80% palate or MX alveolus
  • Begins as black-brown macule
  • Becomes exophytic mass
  • Typically thickened & raised but may be flat early in development
  • Lesion is usually advanced at initial presentation and has poor px
23
Q

ABCDE - Clinical Features of Melanoma

A
  • Asymmetry
  • Border irregularity
  • Color variation
  • Diameter >6mm
  • Evolving
24
Q

Management of Melanoma

A
  • Benign & malignant melanocytic lesions may be clinically indistinguishable in the oral cavity
  • Only way to exclude malignant melanoma is excisional biopsy
  • W/o early intervention, px right now is almost hopeless
25
Q

Tx of Melanoma

A

Tx: Surgical excision

  • Radiation is of limited value
  • Chemo & immunotherapies are evolving
  • Most important px indicator = histologic depth of invasion
    • Melanomas <0.75mm thick have almost 100% 5yr survival
26
Q

Clark Method of Staging

A

Melanoma

  • Stage 1: Melanoma in situ (no invasion)
    • 10yr survival = 96%
  • Stage 2: Tumor in papillary dermis
    • 10yr survival = 96%
  • Stage 3: Tumor to junction papillary and reticular dermis
    • 10yr survival = 90%
  • Stage 4: Tumor in reticular dermis
    • 10yr survival = 67%
  • Stage 5: Tumor in subQ tissue
    • 10yr survival = 26%
27
Q

Areas of poor px for melanoma

A

BANS

  • Interscapular area of the Back
  • Posterior upper Arm
  • Posterior & lateral Neck
  • Scalp
28
Q

Generalized Physiologic Melanotic Lesions of Oral Mucosa

A
  • Symmetric & persistent
  • Does not alter normal architecture
  • Seen in all ages and genders
  • Found in any location, gingiva is most commonly affected
  • Occurs due to increased production of melanin
    • Similar in intensity to skin pigmentation
29
Q

Addison’s Disease

A
  • Insufficient production of adrenal corticosteroid hormones (mineralcorticoids, cortisol)
  • Destruction of adrenal cortex or pituitary gland dysfcn
  • Fatigue, irritability, depression, weakness, hypotension
  • Bronzing: Generalized hyperpigmentation of skin
    • Caused by increased ACTH stimulating melanocytes (primary)
  • Diffuse, brown, macular pigmentation of oral mucosa
  • Dx: Lab test
    • Cortisol <20ug/dL
    • High ACTH: Primary
    • Low/normal ACTH: Secondary
  • Tx: Replacement tx
30
Q

Peutz-Jeghers Syndrome

A
  • Freckle-like lesions of hands, perioral skin & oral mucosa (do not wax/wane w/ sun exposure)
  • Genetic mutation
  • Gastro-intestinal features
    • Intestinal polyposis (not premalignant)
    • Intestinal obstruction due to intussusception
    • GI malignancy: 33% by 60yo
  • Oral lesions seen in 90% of pts
    • Vermillion zone, labial/buccal mucosa, tongue
    • 1-4mm blue-gray macules
  • Tx: Monitored for intussusception or tumor formation; genetic counseling
31
Q

Neurofibromatosis

A
  • Genetic mutation
  • Clinical features
    • Café au lait freckles - 6 freckles at least 1.5cm in diameter needed for dx
    • Axillary freckling
    • Multiple neurofibromas
      • Benign tumor of neural & fibril tissue
    • Lisch nodules
  • Other CNS lesions
  • Increased incidence of neurogenic sarcoma
  • Tx: Symptomatic tx
32
Q

Smoker’s Melanosis

A
  • Most common in anterior gingiva
  • Palate & buccal mucosa from pipe smoking
  • Pigmentation often resolves w/in 3yr after smoking cessation
    • Tobacco is stimulating melanocyte activity
  • Lesion is not premalignant in itself
33
Q

Melasma

A
  • Irregular, symmetric, brown macules on sun-exposed face and lips
  • AKA mask of pregnancy
  • Hypermelanosis
  • Unknown cause but associated w/ pregnancy
  • May also occur with oral contraceptives
  • Estrogen receptor link
34
Q

Medication Induced Pigmentation

A
  • Drug metabolites stimulate melanocytes
  • Most produce diffuse melanosis
  • Estrogen
  • Anti-malarials, anti-psychotics, chemotherapeutics, laxatives, AIDS meds, tetracycline, minocyclines
  • Tx: N/A; d/c drug
35
Q

Heavy Metal Ingestion

A
  • Arsenic, bismuth, platinum, lead, silver, mercury
  • Mainly after occupational exposure to vapors
  • Can be deposited in skin & oral mucosa
  • Gray to black color
36
Q

Amalgam Tattoo

A
  • ST implantation of amalgam particles
  • Passive transfer by chronic friction of mucosa against amalgam restoration
  • Most common pigmentation of oral mucous membranes
  • Typically macular & gray
  • May be detected in rads

Oral Path 1 (10 decks)

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