premalignant disease Flashcards
what is the definition of a premalignant lesion?
A morphologically altered tissue in which cancer is more likely to occur than in its apparently normal counterpart
what is required for diagnosis and assessment of potential malignancy
biopsy
patients with which conditions are more likely to develop oral cancer
- submucous fibrosis
- lichen planus
- lupus erythematosus
- sideropenic dysophagia
- iron deficiency disorder
what is the WHO definition of leukoplakia?
a white patch that cannot be rubbed off and cannot be characterised clinically or histologically as any other disease
what clinical appearances have a lower likelihood of turning into cancer?
Homogenous - lower likelihood of turning into cancer
- Flat
- Plaque like
- Uniformly white
what clinical appearances have a greater likelihood of turning into cancer?
Non-homogeneous - greater likelihood of turning into cancer
- Nodular
- raised
- Verruciform
- Like a wart
- Exophytic
- abnormal growth that sticks out from the surface of a tissue
- Speckled
what is the WHO definition of erythroplakia?
A red patch that cannot be rubbed off and cannot be characterised clinically or histologically as any other disease
significantly higher malignant potential than leukoplakia
what is the definition of oral epithelial dysplasia?
Altered epithelium with an increased risk of developing SCC
what changes occur in oral epithelial dysplasia
Changes in the cells of the epithelium that are similar to those seen in cancer
- Larger cells
- Larger nuclei
- Darker nuclei
- More DNA in them
- Disorganised epithelium
Severity by how large the changes are
what epithelial changes are shown here?
identify
- basal layer is more than one layer thick
- changes in lower third
- mild atypia
mild dysplasia
what epithelial changes are shown here?
identify
- Lots of big cells
- Thicker basal layer
- Lower two thirds are affected
- Changes into middle third
- Moderate atypia
moderate dysplasia
what epithelial changes are shown here?
identify
- Very severe changes
- Affecting whole thickness of the epithelium
- Without invasion
- Epithelium looks malignant but is not invasive
- Abnormal architecture
- Full thickness change
- Pronounced cytological atypia
- Mitotic abnormalities frequent
carcinoma in situ
what is the fate of dysplasic lesions
what percentages?
Resolve - 20-40%
Regress - 17-40%
- Get smaller
No change - 10%
Malignant - 10%
summarise the features associated with increased risk of malignant progression of OPMDs
clinical and histological features
what is the management of dysplastic lesions?
- Stop any associated habits
- Treat infections / deficiencies where applicable
- Early referral for biopsy to assess presence of dysplasia
- Assess risk on clinical and histological grounds
- Mild and moderate
- Clinical observation
- Severe dysplasia and carcinoma in situ
- Surgery to remove lesion
- Drug therapies
- Maintain regular observation and review
- Know when its appropriate to repeat biopsy
identify this
what features are present
what is it associated with
what is the management
chronic hyperplastic candidosis
- mixed red and white patch
- can present as speckled leukoplakia also
- not well defined
- associated with
- smoking
- dysplasia
- malignancy
- managament - eliminate risk factors
- stop smoking
- investigate for diabetes
identify this lesion
what are the features?
what is the risk?
actinic keratosis
- erosions with white borders
- significant risk of cancer development
- must do biopsy
identify this lesion
what are the features?
what is the risk?
cheilitis
- chronic sun exposure
- exophytic mass
- lip is thicker - tumour is filling the lip
- is firm on palpation
- significant risk of cancer development
- must do biospy
identify this lesion
what are the characteristic features
what is the risk of malignancy
lichen planus
- lacey white lines usually
- unable to deteremine how much lichen planus can lead to cancer development
identify this lesion
what is the risk of malignancy
erosive lichen planus
- high risk
