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Minor Oral Surgery > Pre-cancerous lesions > Flashcards

Pre-cancerous lesions Flashcards

1
Q

What is a precancerous lesion?

A

morphologically altered tissue in which cancer is more likely to occur than an apparently normal counterpart

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2
Q

Give an example of a precancerous lesion

A

leukoplakia

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3
Q

What is a precancerous condition?

A

a generalised state associated with a significantly increased risk of developing a malignancy

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4
Q

Give an example of a precancerous condition

A

oral submucous fibrosis

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5
Q

Give examples of clinical lesions that are commonly considered to be premalignant or that can simulate malignant lesions

A
  • leukoplakia
  • erythroplakia
  • leukoerythroplakia
  • smokers keratosis (nicotinic stomatitis)
  • oral submucous fibrosis
  • actinic keratosis/chelitis
  • inherited conditions (dyskeratosis congenita)
  • lichen planus/lichenoid
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6
Q

Give examples of non-pre-malignant white and red lesions

A
  • frictional keratosis
  • oral candidal lesions
  • chemical burns (aspirin)
  • thermal burns
  • pericoronitis
  • gingivitis
  • viral papilloma
  • haemangiomata
  • intra-oral skin grafts restoring surgical defects
  • lingual erythema migrans (geographical tongue)
  • epulides
  • glossitis (drug related or due to deficiency disease)
  • sublingual varicosities
  • intra-oral tattoos and foreign bodies
  • fordyce spots
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7
Q

What kind of diagnosis is leukoplakia regarded as? Why is this

A
  • as a clinical diagnosis
  • a definitive pathological diagnosis can only be established following a biopsy
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8
Q

When and where was the definition of leukoplakia updated?

A

Uppsala conference in 1994

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9
Q

What was the definition of leukoplakia following the Uppsala conference?

A

“predominantly white lesion of oral mucosa which cannot be characterised clinically or pathologically as any other disease; some leukoplakias will transform into oral cancer”

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10
Q

What is homogenous lesion?

A

this is a predominantly white lesion which is uniformly flat and thin.

Some cracking may be evident
Surface may appear crinkled or corrugated but must be of a similar texture throughout

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11
Q

What is a non-homogenous lesion?

A
  • predominantly white or white and red lesion (leukoerythroplakia) which may be flat, nodular or exophytic
  • includes the clinincal lesion of speckled leukoplakia
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12
Q

Many oral cancers manifest as red patches which are asymptomatic and are found at high risk sites. True or false

A

True

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13
Q

Early oral cancer can be sometimes be used to describe…

A

a minimally invasive squamous cell carcinoma of the oral cavity

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14
Q

How does early oral cancer most commonly present?

A
  • erythroplakia with or without patches of keratosis
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15
Q

Where are the commons site of early oral cancer ?

A
  • floor of mouth
  • soft palate complex
  • lateral border of the tongue
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16
Q

Briefly compare/contrast early oral cancer lesions with more advanced lesion with regards to appearance

A
  • EOC lesions do not tend to be ulcerated or indurated (hardened) in comparison to more advanced lesions
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17
Q

Hairly leukoplakia is associated almost exclusively with ________ individuals. What is usually demonstrated within the epithelial cells?

A

Immunocompromised individuals
Epstein Barr birus usually demonstrated within the epithelial cells

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18
Q

In smokers keratosis/nicotinic stomatitis, what are the red interspersed areas ?

A

they are minor salivary glands which have become inflammed

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19
Q

The continuation of the causative smoking habit that led to nicotinic stomatitis can lead to malignant transformation in the future. True or false.
Following your answer, is nicotinic stomatitis a precancerous lesion or a precancerous condition ?

A

true

precancerous condition

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20
Q

What is the cause of reverse smokers palate? What kind of lesion is produced?

A

results from smoking the lit end of the hand-rolled cigarette within the mouth

A premalignant lesion is produced

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21
Q

The signs of oral submucous fibrosis are a response to the use of …

A

Betel Quid

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22
Q

Development of oral submucous fibrosis is also due to genetic input. True or false

A

True

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23
Q

Describe the characteristic histological appearance of oral submucous fibrosis

A
  • dense bands of fibrous tissue which replace elastic tissue in the submucosal tissues and render the mucosa rigid (due to substances that are released from the areca nut - betel quid?)
24
Q

What is the characteristic appearance of the mucosa in oral submucous fibrosis ? What is the cause of this appearance

A
  • petechiae
  • melanosis
  • vesicles

caused by prolonged contact with the tobacco which is often mixed with areca nut in the quid

25
Q

What are the consequences of oral submucosa fibrosis in serious cases?

A
  • severe trismus
  • unable to move tongue
26
Q

Cessation of the betel quid chewing habit is associated with regression of the condition. True or false

A

false

As such regular follow- up is necessary

27
Q

State some treatment options for oral submucous fibrosis

A
  • intralesion corticosteroids
  • surgery
  • both corticosteroid and surgery to release tight banding
  • surgery may lead to further fibrous scarring
28
Q

What is the cause of actinic keratosis ?

A

it is the result of a cumulative effect of ultraviolet radiation on exposed areas of skin and oral mucosa

(sun damage)

29
Q

What are the clinical features of oral actinic keratosis ?

A
  • irregular scaly plaques on an erythematous background
  • keratin horn is occasionally felt on palpation
30
Q

Actinic keratosis is a ____________ lesion

A

premalignant

31
Q

What are the preferred methods of treatment for actinic keratosis ?

A

surgical excision
cryosurgery

32
Q

What other condition is analogous to actinic keratosis ?

A

actinic chelitis

33
Q

What is the best way to prevent actinic keratosis?

A

application of sunscreen to the lips

34
Q

Give examples of genetically determined mucosal lesions

A
  • white sponge naevus
  • pachynochia congenita
  • Xeroderma pigmentosum
  • Dyskeratosis congenita
35
Q

White sponge naevus may not present clinically until adulthood. True or false

A

true

36
Q

What is pachyonychia congenita ?

A
  • autosomal dominant benign condition
  • characterised by oral keratosis and palmar- plantar keratosis
  • no tendency for malignant transformation
37
Q

How is xeroderma pigmentosum manifested?

A
  • numerous cutaneous and oral malignancies in middle age
38
Q

What is thought to be the pattern of inheritance of dyskeratosis congenita?

A

thought to be X linked due to the preponderance of males affected

39
Q

How does dyskeratosis congenita present?

A
  • tongue and buccal mucosa develop bullae which become erosions and finally leukoplakic lesion
40
Q

What is the frequency/ incidence of dyskeratosis congenita lesions that undergo malignant transformation?

A

approximately one-third undergo malignant transformation

41
Q

What conditions are often associated with dyskeratosis congenita?

A
  • aplastic anaemia
  • severe periodontal disease
42
Q

What areas of the oral mucosa are affected by lichen planus?

A
  • buccal mucosa
  • tongue
  • less often the gingivae
43
Q

What form of lichen planus is most often associated with malignant transformation?

A

the more atrophic (wasting away) forms
Erosive lichen planus

44
Q

Why is it important for lesions to be palpated ?

A
  • detection of induration (hardness)
  • detection of adherence (does it rub off or not?)
45
Q

During a routine examination, what adjuncts/techniques can you make use of to examine the mucosa?

A
  • drying the saliva as it may be disguised by it
  • mucosal stains
46
Q

Give some examples of mucosal stains

A
  • OraScan
  • Germiphene
  • Canada
47
Q

State an advantage and disadvantage of using mucosal stains. What is the consequence of this?

A

Advantage:
* high sensitivity for carcinoma
* relative sensitivity for dysplasia

Disadvantage
* low specificity in general hence ability to detect lesions that are not malignant is low but can detect lesions that are premalignant/malignant

Thus, the only feasible use is in the surveillance of high risk subjects

48
Q

What should a histopathological report include following a biopsy of a lesion?

A
  • estimation of the level of dysplasia within the lesion
  • exclude the possibility that invasion has already occured
49
Q

What is dysplasia?

A

it is a disorded maturation of mucosa in response to physical, chemical and microbiological irritants

50
Q

When can dysplastic epithelium become neoplastic?

A

If the causative stimulus is not promptly discontinued

51
Q

What is the importance/significance of determining the level of dysplasia?

A

It is important for the clinician with regard to appropriate management of the lesion

52
Q

What sites in the oral mucosa are thought to be of greater risk of malignancy if a lesion were present?

A
  • floor of mouth
  • tongue - ventral and posterior surfaces
  • retromolar areas
53
Q

What investigations can be carried out with a blood testafter discovering a lesion ?

A
  • full blood count
  • vitamin B12 assay
  • folic acid assay
  • random glucose sample
54
Q

What is the benefit of clinical photography of oral lesions?

A

excellent method of recording changes in the lesions

55
Q

What treatment options can be considered for treatment of lesions?

A
  • biopsy of erythematous regions
  • excisional biopsy
  • laser treatment
  • regular observation with serial biopsy (may be best for larger lesions)
  • vitamin A analogues- retinoids
56
Q

What preventive advice should be give with regards to development of oral lesions/cancers?

A
  • smoking and alcohol cessation
  • their rolse in the aetiology of cancer is well documented and their synergistic effetcs are well recognised
57
Q

Most cases of oral cancer are de novo. How do other oral cancer lesions present ?

A

some cancer lesions can mimic precancerous lesions

Minor Oral Surgery (36 decks)

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