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ORAL PATHOLOGY > Premalignant Epithelial Lesions > Flashcards

Premalignant Epithelial Lesions Flashcards

1
Q

Premalignant Epithelial Lesions 5

A 
leukoplakia
erythoplakia
acitinic keratosis 
actinic cheilitis
oral submucous fibrosis
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2
Q

white patch of the oral mucosa that can’t be wiped off

A

leukoplakia

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3
Q

most common site for leukoplakia

A

buccal mucosa

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4
Q

color of leukoplakia is due to

A

thickened keratin

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5
Q

most common oral precancer

A

leukoplakia

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6
Q

seen w/use of smokless tobacco

A

tobacco pouch keratosis

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7
Q

tobacco pouch keratosis can cause

A

gingival recession and facial alveolar bone loss

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8
Q

3 main types of tobacco in US

A

chewing tobacco
dry snuff
moist snuff

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9
Q

tobacco pouch keratosis

A

tobacco pouch keratosis- white/ gray , corrugated does not disappear stretching the mucosa, sometimes pouch

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10
Q

what has a higher risk for malignant transformation for tobacco?

A

dry snuff

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11
Q

gray translucent appearance is contact irritation

A

tobacco pouch keratosis

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12
Q

describe leukoplakia

A

sharply demarcated white plaque with smooth, vercuous, or micronodular surface

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13
Q

wart like projections

A

verrucous leukoplakia

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14
Q

lateral spread and involving multiple sites

A

proliferative verrucous leukoplakia

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15
Q

keratotic plaques, rough surface projections

A

proliferative verrucous leukoplakia

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16
Q

which leukoplakia displays persistent growth

A

proliferative verrucous leukoplakia

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17
Q

usually develop dysplasia

A

proliferative verrucous leukoplakia

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18
Q

often transform into squamous cell carcinoma within 8 years

A

proliferative verrucous leukoplakia

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19
Q

associated with viadent toothpaste

A

sanguinaria associated leukoplakia

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20
Q

leukoplakia high risk sites

A

ventral tongue
floor of mouth
soft palate/tonsillar pillars

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21
Q

typically some degree of hyperkeratosis

A

leukoplakia

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22
Q

treatment for leukoplakia for no or mild dysplasia

A

D/C carcinogenic habits

watch

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23
Q

moderate dysplasia or worse,

A

D/C carcinogenic habits, remove by most convenient means available

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24
Q

_____ of non-dysplastic lesions will transform if not treated in leukoplakia

A

15%

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25
Q

_____ of dysplastic lesions will transform in leukoplakia

A

33%

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26
Q

______ of leukoplakia will recur, even after complete clinical excision

A

30%

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27
Q

reverse smoker’s palate

A

diffuse keratosis of the palate significant risk of epithelial dysplasia/carcinoma

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28
Q

red patch that cannot be diagnosed as any other condition clinically/microscopically

A

erythroplakia

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29
Q

velvety demarcated patch,

A

erythroplakia

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30
Q

why are erythoplakia’s red

A

red appearance is due to the lack of keratin production on the surface of the lesion

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31
Q

____ of erythoplakias are severe epithelial dysplasia or worse at time of biopsy

A

90%

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32
Q

premalignant sun-induced skin lesion

A

actinic keratosis

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33
Q

Places actinic keratosis occurs (3)

A

facial skin, vermillion zone, lower lip

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34
Q

Demographics of actinic keratosis

A

fair-skinned person >40

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35
Q

scaly plaque w/sandpaper texture

A

actinic keratosis

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36
Q

may have erythematous base

A

actinic keratosis

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37
Q

some degree of epithelial dysplasia or even superficially invasive squamous cell carcinoma

A

actinic keratosis

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38
Q

Tx options for actinic keratosis (7)

A 
liquid nitrogen 
Surgical excision
laser ablation 
5-fluoro-uracil (Effudex)
imiquimod (Aldara)
Mohs micrographic surgery
reduce sun exposure
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39
Q

prognosis of actinic keratosis

A

fair to good

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40
Q

actinic keratosis involving the vermillion zone of the lower lip

A

actinic cheilitis

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41
Q

Clinical features of actinic cheilitis (4)

A

chronic scaling
crusting
ulceration
fissuring of the lip

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42
Q

actinic cheilitis lesions develop ____.

A

slowly

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43
Q

Epithelium of actinic cheilitis may exhibit (3)

A

hyperkeratosis
acanthosis (thickening)
atrophy

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44
Q

basophilic change of CT caused by UV damage

A

solar elastosis

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45
Q

solar elastosis is associated with

A

actinic cheilitis

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46
Q

Tx of actinic cheilitis

A 
vermilionectomy 
laser ablation of vermillion zone 
electrodessication
5-FU
cryotherapy 
reduce sun exposure
biopsy/re-biospy
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47
Q

risk for transformation of actinic cheilitis of SCC is ____ than for actinic keratosis

A

2.5

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48
Q

erythroplakia

A

usually affecting the lateral tongue, floor of the mouth, or soft palate

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49
Q

malignancies of surface epithelial origin (4)

A 
basal cell carcinoma 
cutaneous squamous cell carcinoma 
squamous cell carcinoma of the lip 
oral squamous cell carcinoma 
verrucous carcinoma
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50
Q

most common skin cancer

A

basal cell carcinoma

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51
Q

basal cell carcinoma arises from the

A

basal cells of the epidermis

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52
Q

basal cell carcinoma occurs where?

A

any cutaneous site
80% H/N
*mask

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53
Q

occurs in M>F (3)

A

basal cell carcinoma, OSCC, verrucous carcinoma

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54
Q

risk factor tendency for freckling in childhood?

A

basal cell carcinoma

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55
Q

PUVA for psoriasisis

A

risk factor for basal cell carcinoma

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56
Q

tanning beds

A

risk factor for BCC

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57
Q

immunosuppression

A

risk factor for BCC

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58
Q

Types of BCC (6)

A 
Nodulo-ulcerative BCC 
Pigmented BCC
Sclerosing (morpheaform) BCC
Superficial BCC 
BCC associated syndromes 
fibroepithelioma
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59
Q

most common BCC

A

nodulo-ulcerative BCC

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60
Q

least common BCC

A

sclerosing (morpheaform) BCC

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61
Q

firm painless papule

A

nodulo-ulcerative BCC

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62
Q

rolled borders

A

nodulo-ulcerative BCC

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63
Q

central umbilication (depression) often ulcerates

A

nodulo-ulcerative BCC

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64
Q

pearly, opalescent when pressed

A

nodulo-ulcerative BCC

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65
Q

no hair

A

nodulo-ulcerative BCC

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66
Q

telangiectasia

A

nodulo-ulcerative BCC

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67
Q

hx of intermittent bleeding/healing

A

nodulo-ulcerative BCC

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68
Q

uniform, ovoid dark-staining basaloid cells

A

nodulo-ulcerative BCC

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69
Q

basaloid cells appear to drop off

A

nodulo-ulcerative BCC

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70
Q

(2) large lobules of tumor cells

A

nodulo-ulcerative BCC

pigmented BCC

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71
Q

three descriptors of pigmented BCC

A

resemble melanocytic nevi, short duration, lack of hair

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72
Q

colonization by benign melanocytes

A

pigmented BCC

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73
Q

most aggressive type of BCC

A

sclerosing (morpheaform) BCC

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74
Q

resembles scar

A

sclerosing (morpheaform) BCC

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75
Q

difficult to assess borders

A

sclerosing (morpheaform) BCC

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76
Q

describe histopathologic features of sclerosing BCC

A

infiltrative nests of tumor cells in collagenous background

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77
Q

prognosis of BCC

A

excellent

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78
Q

most common oral malignancy

A

squamous cell carcinoma

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79
Q

2nd most common cutaneous malignancy

A

squamous cell carcinoma

80
Q

arises from surface epithelium/epidermis

A

squamous cell carcinoma

81
Q

Type of SCC (3)

A

1) Squamous cell carcinoma of the lip
2) oral squamous cell carcinoma
3) cutaneous SCC

82
Q

Risk Factors for cutaneous SCC (3)

A

chronic UV light exposure
medical ionizing radiation
pre-existing actinic keratosis

83
Q

Clinical Features of cutaneous SCC (5)

A

70% H/N, slow non-healing ulcer, plaque/papule/nodule, variable scale/crust, erythematous base

84
Q

SCC of the lip usually occurs where?

A

LL

85
Q

RF for SCC of the lip

A

chronic UV light exposure

86
Q

Describe SCC of the lip (5)

A

rough, scaly
ulcerated
slow, from acetnic cheilitis

87
Q

histopathology of SCC of the lip?

A

well-differentiated

88
Q

TX for SCC of the lip (4)

A

scalpel excision
vermilionectomy
reduce sun exposure
use SPF

89
Q

prognosis for SCC of the lip

A

good for LL
bad for UL
good if ID early

90
Q

most common oral maligancy

A

OSCC

91
Q

_____ associated w/tobacco for OSCC

A

75-80%

92
Q

most common site for OSCC

A

tongue (posterior/lateral, ventral)

93
Q

Sites for OSCC (6)

A 
tongue
floor of mouth
gingiva
labial/buccal mucosa
soft palate
hard palate
94
Q

Fe defiency anemia is risk factor for?

A

OSCC

95
Q

what population is risk factor for OSCC

A

M>50 years

96
Q

describe lesion for OSCC (6)

A

pain, exophytic, endophytic, leukoplakia, erytheoleukoplakia, erythoplakia

97
Q

describe endophytic lesion for OSCC

A

invasive, burrowing, ulcerated

98
Q

describe exophytic lesion for OSCC (4)

A

mass-forming, fungating, papillary, and verruciform

99
Q

describe radiographic feature of SCC (3)

A

moth eaten radiolucency
ill defined
pathologic fracture possible

100
Q

Histopatholgic Features of OSCC (3)

A
  • invasive cords/nests of malignant epithelial cells from dysplastic epithelium
  • increased N/C ratio, pleomorphism, mitoses
  • varying degrees keratin production
101
Q

Tx for OSCC (6)

A 
wide surgical excision
radiation therapy
chemotherapy
all/combo above
neoadjuvant therapy
molecular based
102
Q

Prognosis for OSCC

A

poor, most present in stage 3/4

103
Q

in OSCC, ____ of these patients will develop aerodigestive tract maligancies

A

10-25%

104
Q

uncommon form of SCC, less agressive

A

verrucous carcinoma

105
Q

SCC assoc. with dry snuff

A

verrucous carcinoma

106
Q

verrucous carcinoma affects which population?

A

elderly male (females-dry snuff)

107
Q

verrucous carcinoma affects where? (5)

A

mandibular buccal vestibule, buccal muocsa, gingiva, tongue, hard palate

108
Q

describe lesion of verrucous carcinoma? (5)

A

well-defined, painless, thick plaque, papillary verruciorm projectsions, white/erythematous/pink

109
Q

verrucous carcinoma histopathologic features? (3)

A

wide, pushing rete ridges
rough papillary surface
keratin plugging

110
Q

conventional SCC dev. in ____ of tumors?

A

20%

111
Q

tx of verrucous carcinoma

A

surgical excision

112
Q

prognosis of verrucous carcinoma

A

90% disease free after 5 years

113
Q

name melanocytic lesions (7)

A 
ephelis 
actinic lentigo
melanotic macule 
acquired melanocytic nevus
congenital melanocytic nevus 
blue nevus 
melanoma
114
Q

“freckles”

A

ephelis (plur. ephelides”

115
Q

ephelides are usually located where?

A

face, arm, back

116
Q

common, harmless melnanocytic lesions that appear on sun-exposed skin?

A

actinic lentigo

117
Q

“age spots” or “liver spots”

A

actinic lentigo

118
Q

clinical marker of UV damage

A

actinic lentigo

119
Q

don’t wax and wane with sun exposure

A

actinic lentigo

120
Q

actinic lentigo occurs where?

A

face, dorsum of hands

121
Q

tx for actinic lentigo?

A

none, unless for esthetic

122
Q

common, harmless lesion w/maximum dimension achieved rapidly then remains constant

A

melanotic macule

123
Q

etiology of melanotic macule?

A

unknown etiology

124
Q

population of melanotic macule?

A

female, 43

125
Q

melanotic macule occurs where?

A

lip/oral mucosa

126
Q

three descriptors of melanotic macule?

A

tan to dark brown

<7mm, demarcated margins

127
Q

three histopathologic features of melanocytic macule?

A

increased melanin pigmentation along basal epithelial layer

  • melanin incontinence
  • normal stratified squamous epithelium
128
Q

tx for melanotic macule?

A

none, unless recent onset/large size, irregular pigmentation, unknown duration

129
Q

prognosis of melanotic macule?

A

benign, one report of malignant transformation

130
Q

dermatologic term for mole

A

acquired melanocytic nevus

131
Q

most common of all human tumors

A

acquired melanocytic nevus

132
Q

population of acquired melanocytic nevus?

A

childhood, 4th decade, caucasian

133
Q

what gradually involutes with age

A

acquired melanocytic nevus

134
Q

acquired melanocytic nevus occurs where?

A

most above the waist
H/N common
skin or mucosa

135
Q

5 features w/acquired melanocytic nevus?

A 
macules/papules
sharply demarcated
brown, black, tan, skin-colored
<6mm
hair
136
Q

in the oral cavity, where do acquired melanocytic nevus occur? (2)

A

hard palate

attached gingiva

137
Q

three stages of acquired melanocytic nevus

A

junctional stage
compound stage
intradermal stage

138
Q

tx of all unexplained pigmented oral lesions?

A

excisional biopsy

139
Q

tx for acquired melanocytic nevus?

A

none for cutaneous nevi

unless chronically irritated, esthetic concern of changes in size/color

140
Q

prognosis for acquired melanocytic nevus?

A

low risk of malignant transformation

1/3000-10,000

141
Q

how common is congenital melanocytic nevus

A

1% of newborns

142
Q

congenital melanocytic nevus usually occurs where?

A

trunk/extremities

15% H/N

143
Q

what lesion has hypertrichosis?

A

congenital melanocytic nevus

144
Q

treatment of congenital melanocytic nevus? (5)

A

excise for esthetic reasons

dermabrasion/chemical peel/laser/cryotherapy/partial surgical excision

145
Q

prognosis for congenital melanocytic nevus?

A

1% for malignant transformation for small-excision

2-3% large transform-staged excision

146
Q

where do blue nevus occur cutaneously? (4)

A

hands, feet, scalp, face

147
Q

where do blue nevi occur mucosally?

A

oral/conjunctival

148
Q

bluish or blue gray due to depth of melanin pigment

A

Tyndall effect-blue nevus

149
Q

demographic of blue nevus?

A

children, young adults, females

150
Q

size of blue nevus?

A

<1cm macule/papule

151
Q

most common oral site of blue nevus?

A

palate

152
Q

blue nevus histopathologic features? (3)

A
  • elongated dendritic melanocytes in CT
  • abundant melanin pigment
  • no atypia
153
Q

tx of blue nevus?

A

conservative excision

biopsy all unexplained pigmented oral lesions

154
Q

prognosis of blue nevus

A

excellent
recurrence rare
malignant transformation rare, but reported

155
Q

third most common skin cancer

A

melanoma

156
Q

risk factors for melanoma (9)

shoot for three each time

A 
whites-fair skinned-sunburn freckle easily 
light hair/eyes
genetic predisposition of melanoma 
personal history of melanoma 
indoor occupation/outdoor recreation 
hx of dysplastic or congenital nevus 
>100 common nevi
immnocompromised-organ transplant
157
Q

clinical features of melanoma

A

40-70yrs, females <40
male in older
overall mostly males

158
Q

what percent of melanoma are cutaneous sites?

A

91% cutaneous

159
Q

high risk sites and percentage for melanoma

A

40/BANS

160
Q

H/N make up what percent of melanoma

A

25%

161
Q

mucosa makes up what percent of melanoma?

A

1%

162
Q

Clinical features of melanoma

A 
ABCDE
A=assymetry
b=border irregularity
C=color variegation
D: diameter >6mm
E=evolving
163
Q

melanoma growth phases?

A

radial-laterally

vertical: extends deeper into CT

164
Q

precursor of melanoma?

A

lentigo maligna

165
Q

clinicopathologic types of melanoma? 4

A

lentigo maligna melanoma
superficial spreading melanoma
nodular melanoma
acral lentiginous melanoma

166
Q

hutchinson’s freckle?

A

lentigo maligna

167
Q

melanoma in pureply radial growth phase?

A

melanoma in-situ

168
Q

demographics of lentigo maligna + location ?

A

older individuals w/fair complexion + facial skin

169
Q

lentigo maligna melanoma what % arise in lentigo maligna?

A

5%

170
Q

nodularity in previously flat lentigo maligna signals what?

A

vertical growth phase

lentigo maligna melanoma

171
Q

what percent of melanoma is superficial spreading?

A

70%

172
Q

what percent of superficial spreading melanoma is in H/N?

A

15-20%

173
Q

4 clinical features of superficial spreading melanoma?

A

interscapular area of Men
back of legs of women
begins as a macule/plaque
classic clinical features (ABCDES)

174
Q

rapidly growing nodule?

A

nodular melanoma

175
Q

what percent of melanoma is nodular melanoma?

A

15%

176
Q

what percent of nodular melanoma is H/N

A

33%

177
Q

describe growth of nodular melanoma?

A

almost immediate vertical phase if little if any radial growth

178
Q

describe appearance of nodular melanoma? (2)

A

deeply pigmented

amelanotic

179
Q

most common form oral melanoma

A

acral lengtinous

180
Q

what percent of melanoma is acral lentiginous?

A

8%

181
Q

most common melanoma in persons of color?

A

acral lentiginous

182
Q

more aggressive form of melanoma over cutaneous?

A

acral lentiginous

183
Q

sites of acral lentiginous? (4)

A

palms of hands
soles of feet
subungal
mucous membranes

184
Q

description of acral lentiginous? (3)

A

dark-color variation
irregular margin
macule which dev. into nodule

185
Q

desciption of oral acral lentiginous?

A

dark-may see color variation
*amelanotic
*irregular margin
macule which dev. into nodule

186
Q

population of acral lentinigous?

A

male, 5-7th decade

187
Q

location of oral acral lentinigous?

A

hard palate/maxillary alveolar mucosa 70%-80%

188
Q

4 clinical features of acral lentigionous?

A

ulceration/pain/soft to palpation/cervical lymph node metastasis

189
Q

radiographic appearance of acral lentiginous?

A

irregular radiolucency/mixed lesion

190
Q

tx of melanoma?

A

surgical excision 1-2cm margin for cutaneous

  • lymph node dissection
  • genotype-directed immunotherapy
191
Q

prognosis of melanoma

A

depth of invasion
<0.75mm-96% 10 year survival
>3.6 mm- 26% 10 year survival
better prognosis for younger than 50, F

192
Q

where is prognosis for melanoma worse?

A

worse for cutaneous on trunk, H/N (esp scalp/neck)

worse for mucosal than cutaneous

193
Q

what is the prognosis for oral melanoma?

A

5 year survival rate 10-25%
difficult achieving wide surgical margin s
*early metastasis

194
Q

routes of metastasis for melnaoma

A

lymphatics
blood
brain/liver/bone

195
Q

M>50 (two conditions)

A

leukoplakia, OSCC

196
Q

80% of leukoplakia show what

A

hyperkeratosis without epithelial dysplasia

ORAL PATHOLOGY (3 decks)

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