Premalignant Epithelial Lesions

Question 1

Leukoplakia definition

Answer 1

a white patch of the oral mucosa that cannot be scraped off and cannot be diagnosed clinically or microscopically as any other condition

clinical term only

Question 2

how do you diagnose Leukoplakia?

Answer 2

biopsy is mandatory

Question 3

What are the risk factors for Leukoplakia?

Answer 3

adult males (+ 50 yo)
tobacco use, especially cigarettes

Question 4

appearance of a leukoplakia

Answer 4

sharply demarcated white plaque with smooth, verrucous or micronodular surface

red component present? “speckled leukoplakia”

Question 5

Sanguinara-associated Leukoplakia

Answer 5

patients have used viadent toothpaste or mouthwash that contain sanguinara (indian blood root) extract

Question 6

what does sanguinara associated leukoplakia affect?

Answer 6

mx buccal gingiva and vestibule

Question 7

when was sanguinara assoc leukoplakia reported

Answer 7

1999

Question 8

what is seen histopathologically in sanguinaria assoc leukoplakia?

Answer 8

epithelial atypia or mild dysplasia

Question 9

common risk sites for leukoplakia?

Answer 9

lateral tongue, floor mouth and tonsillar pilar/soft palate area

Question 10

leukoplakia histology

Answer 10

hyperkeratosis (wet keratin appears white)
sharply demarcated from normal epi

precancerous changes can be seen microscopically (epithelial dysplasia) –> mild, moderate or severe dysplasia or carcinoma in situ (dysplasia top to bottom)

Question 11

leukoplakia tx

Answer 11

controversial
for no dysplasia or moderate dysplasia – watch and stop the carcinogenic habits

for moderate to severe dysplasia use the most CONVENIENT means possible - laser ablation or scalpel

Question 12

leukoplakia prognosis

Answer 12

guarded

Question 13

% of non-dysplastic lesions transform in leukoplakias?

Answer 13

15%`

Question 14

% of dysplastic lesions that transform in leukoplakia?

Answer 14

33%

Question 15

% the a leukoplakia will reoccur?

Answer 15

30% (even if completely removed!)

Question 16

Erythroplakia definition

Answer 16

a red patch that cannot be diagnosed by any other condition clinically or microscopically

Question 17

what is more serious leukoplakia or erythroplakia?

Answer 17

erythroplakia

Question 18

erythroplakai epidemiologic features and risk factors

Answer 18

same as leukoplakia (male, smoker)

Question 19

appearance of erythoplakia

Answer 19

velvety red, well demarcated patch

Question 20

at the time of most biospys, what do erythroplakias look like microscopically?

Answer 20

90% have severe dysplasia or worse (more advanced than leukoplakia)

Question 21

what are erythoplakias red?

Answer 21

lack of keratin production of the surface lesion

Question 22

tx of erythroplakia

Answer 22

same as that of a leukoplakia (dependent of epithelial dysplasia)

Question 23

actinic keratosis definition

Answer 23

pre-malignant sun induced skin lesion caused by UV light exposure or hx of radiation

Question 24

common sites for actinic keratosis

Answer 24

common on the facial skin and vermillion zone of the lips in the fair-skinned persons over 40 yo.

Question 25

appearance of actinic keratosis

Answer 25

scaly plaque with sandpaper texture

Question 26

histology actinic keraotis

Answer 26

hyprkeratosis, usually parakeratin

some degree of epi dysplasia or superficial invasive SCC seen histopathologically

Question 27

tx of actinic keratosis

Answer 27

skin lesions txed with topical liquid nitrogen, surgical excision, laser ablation, 5-fluoro-uracil (effudex) or imiquimod (aldara)

Question 28

prognosis of actinic keratosis ?

Answer 28

fair to good

*need to monitor pt for development of new lesions

Question 29

actinic cheilosis (cheilitis)

Answer 29

actinic keratosis that involves the vermillion zone of the lower lip

Question 30

appearance actinic chelitis

Answer 30

chronic scaling, crusting, ulceration and/or fissuring of the lip

Question 31

tx of actinic chelitis

Answer 31

vermillionectomy with advancement of the labial mucosa or laser ablation of the involved vermillion zone