Premalignant Epithelial Lesions Flashcards
Leukoplakia definition
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
how do you diagnose Leukoplakia?
biopsy is mandatory
What are the risk factors for Leukoplakia?
adult males (+ 50 yo) tobacco use, especially cigarettes
appearance of a leukoplakia
sharply demarcated white plaque with smooth, verrucous or micronodular surface
red component present? “speckled leukoplakia”
Sanguinara-associated Leukoplakia
patients have used viadent toothpaste or mouthwash that contain sanguinara (indian blood root) extract
what does sanguinara associated leukoplakia affect?
mx buccal gingiva and vestibule
when was sanguinara assoc leukoplakia reported
1999
what is seen histopathologically in sanguinaria assoc leukoplakia?
epithelial atypia or mild dysplasia
common risk sites for leukoplakia?
lateral tongue, floor mouth and tonsillar pilar/soft palate area
leukoplakia histology
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)
leukoplakia tx
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
leukoplakia prognosis
guarded
% of non-dysplastic lesions transform in leukoplakias?
15%`
% of dysplastic lesions that transform in leukoplakia?
33%
% the a leukoplakia will reoccur?
30% (even if completely removed!)
Erythroplakia definition
a red patch that cannot be diagnosed by any other condition clinically or microscopically
what is more serious leukoplakia or erythroplakia?
erythroplakia
erythroplakai epidemiologic features and risk factors
same as leukoplakia (male, smoker)
appearance of erythoplakia
velvety red, well demarcated patch
at the time of most biospys, what do erythroplakias look like microscopically?
90% have severe dysplasia or worse (more advanced than leukoplakia)
what are erythoplakias red?
lack of keratin production of the surface lesion
tx of erythroplakia
same as that of a leukoplakia (dependent of epithelial dysplasia)
actinic keratosis definition
pre-malignant sun induced skin lesion caused by UV light exposure or hx of radiation
common sites for actinic keratosis
common on the facial skin and vermillion zone of the lips in the fair-skinned persons over 40 yo.
appearance of actinic keratosis
scaly plaque with sandpaper texture
histology actinic keraotis
hyprkeratosis, usually parakeratin
some degree of epi dysplasia or superficial invasive SCC seen histopathologically
tx of actinic keratosis
skin lesions txed with topical liquid nitrogen, surgical excision, laser ablation, 5-fluoro-uracil (effudex) or imiquimod (aldara)
prognosis of actinic keratosis ?
fair to good
*need to monitor pt for development of new lesions
actinic cheilosis (cheilitis)
actinic keratosis that involves the vermillion zone of the lower lip
appearance actinic chelitis
chronic scaling, crusting, ulceration and/or fissuring of the lip
tx of actinic chelitis
vermillionectomy with advancement of the labial mucosa or laser ablation of the involved vermillion zone
