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Oral Med > Pimented lesions > Flashcards

Pimented lesions Flashcards

1
Q

What is the most common oral mucosal lesion of melanocytic origin?

A

Melanotic macule.

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2
Q

How does a melanotic macule present?

A

Small, solitary, well-circumscribed, uniformly pigmented.

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3
Q

What are the most common sites for a melanotic macule?

A

Lower lip, gingiva, and palate but any mucosal site can be affected

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4
Q

What are the differential diagnoses for a melanotic macule? (3)

A
  • Malignant melanoma,
  • melanocytic nevus (blue),
  • amalgam tattoo.
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5
Q

Is smoker’s melanosis considered pre-neoplastic?

A

No, it is not considered pre-neoplastic.

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6
Q

What might cause smoker’s melanosis?

A

unknown aetiology but Thought to be a protective mucosal response to heat or irritants.

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7
Q

How does smoker’s melanosis present?

A

Diffuse, patchy, irregular pigmentation of anterior facial maxillary and mandibular gingivae.

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8
Q

What are the two types of drug-induced melanosis?

A

Mucosa appears pigmented (not true pigmentation) and true pigmentation through melanin induction.

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9
Q

What drugs are commonly associated with drug-induced melanosis?

A
  • Tetracycline
  • antimalarials (chloroquine, chlorpromazine)
  • oral contraceptives.
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10
Q

What does drug-induced melanosis look like

A

diffuse but localised to one mucosal region or multifocal

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11
Q

What is malignant melanoma?

A

Cancer arising from malignant melanocytes - most deadly primary skin cancer

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12
Q

What is the prognosis for malignant melanoma in mucosal sites?

A

Poorer prognosis than in the skin.

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13
Q

typical demographic of malignant melanoma

A

Typically occur over age 50, highest incidence in Japanese

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14
Q

where does malignant melanoma most commonly affect

A

Most commonly affects hard palate and maxillary gingivae

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15
Q

What is the typical presentation of malignant melanoma?

A
  • Macule, plaque or mass
  • Well-circumscribed or irregular
  • Focally or diffusely pigmented, can even lack pigment
  • Non-specific: ulceration, pain, paraesthesia/anaesthesia, tooth mobility or spontaneous exfoliation, root resorption, bone loss
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16
Q

What is hypoadrenocorticism / Addison’s disease?

A

Potentially life-threatening disease due to adrenal destruction or impairment caused by trauma, autoimmune diseases, infectious agents, neoplasia, genetics, certain medications and iatrogenic causes

17
Q

how does hypoadrenocorticism / Addison’s disease occur?

A
  • Corticosteroid levels decrease → anterior pituitary gland stimulated to increase synthesis of
  • ACTH → ACTH acts on adrenal cortex to stimulate corticosteroid production → negative feedback look from pituitary to slow ACTH production
    - If low corticosteroid levels persist, there is persistent ACTH production
18
Q

What is one of the earliest signs of hypoadrenocorticism / Addison’s disease?

A

Diffuse mucocutaneous pigmentation on multiple surfaces.

19
Q

What are some associated features of Addison’s disease?

A

Hypotension, easy bruising, fatigue, mood swings, weakness.

20
Q

What causes Cushing disease?

A

Caused by primary activating pituitary pathology caused by prolonged exposure to high concentrations of endogenous or exogenous corticosteroids

21
Q

What is one of the earliest signs of Cushing disease?

A

Diffuse mucocutaneous pigmentation.

22
Q

What are some associated features of Cushing disease?

A

Weight gain, hypertension, diabetes, osteoporosis, dyslipidaemia, moon face.

23
Q

What is Peutz-Jehgers syndrome

A

Rare genetic disease in tumour suppressor gene

24
Q

What characterises Peutz-Jeghers syndrome?

A

Intestinal polyposis and increased susceptibility to cancer.

25
Q

How does Peutz-Jeghers syndrome present in the mouth?

A

Distinctive pattern of perioral and acral macular pigmentation = one of earliest signs

26
Q

What do the spots in Peutz-Jehgers syndrome mimic and name?

A

Usually mimics dark freckling but without reliance of sun exposure to increase or diminish intensity - Cafe au Lait

27
Q

What is Kaposi’s sarcoma

A

Commonest tumour associated with HIV

28
Q

What is Kaposi’s sarcoma associated with?

A

HIV and human herpesvirus 8/Kaposi’s sarcoma virus.

29
Q

How does Kaposi’s sarcoma present?

A

Painless skin or mucosa patches – red to violet patches that become larger and darker with time

30
Q

Where is Kaposi’s sarcoma most commonly found in the mouth?

A

Palate, followed by gingiva and tongue.

31
Q

Where is Kaposi’s sarcoma most commonly found on the face?

A

tip of nose

32
Q

how is kaposi sarcoma treated

A

No cure – may respond to chemo/radiotherapy

Oral Med (10 decks)

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