Premalignant Epithelial Lesions Flashcards
1
Q
Premalignant Epithelial Lesions 5
A
leukoplakia erythoplakia acitinic keratosis actinic cheilitis oral submucous fibrosis
2
Q
white patch of the oral mucosa that can’t be wiped off
A
leukoplakia
3
Q
most common site for leukoplakia
A
buccal mucosa
4
Q
color of leukoplakia is due to
A
thickened keratin
5
Q
most common oral precancer
A
leukoplakia
6
Q
seen w/use of smokless tobacco
A
tobacco pouch keratosis
7
Q
tobacco pouch keratosis can cause
A
gingival recession and facial alveolar bone loss
8
Q
3 main types of tobacco in US
A
chewing tobacco
dry snuff
moist snuff
9
Q
tobacco pouch keratosis
A
tobacco pouch keratosis- white/ gray , corrugated does not disappear stretching the mucosa, sometimes pouch
10
Q
what has a higher risk for malignant transformation for tobacco?
A
dry snuff
11
Q
gray translucent appearance is contact irritation
A
tobacco pouch keratosis
12
Q
describe leukoplakia
A
sharply demarcated white plaque with smooth, vercuous, or micronodular surface
13
Q
wart like projections
A
verrucous leukoplakia
14
Q
lateral spread and involving multiple sites
A
proliferative verrucous leukoplakia
15
Q
keratotic plaques, rough surface projections
A
proliferative verrucous leukoplakia
16
Q
which leukoplakia displays persistent growth
A
proliferative verrucous leukoplakia
17
Q
usually develop dysplasia
A
proliferative verrucous leukoplakia
18
Q
often transform into squamous cell carcinoma within 8 years
A
proliferative verrucous leukoplakia
19
Q
associated with viadent toothpaste
A
sanguinaria associated leukoplakia
20
Q
leukoplakia high risk sites
A
ventral tongue
floor of mouth
soft palate/tonsillar pillars
21
Q
typically some degree of hyperkeratosis
A
leukoplakia
22
Q
treatment for leukoplakia for no or mild dysplasia
A
D/C carcinogenic habits
watch
23
Q
moderate dysplasia or worse,
A
D/C carcinogenic habits, remove by most convenient means available
24
Q
_____ of non-dysplastic lesions will transform if not treated in leukoplakia
A
15%
25
_____ of dysplastic lesions will transform in leukoplakia
33%
26
______ of leukoplakia will recur, even after complete clinical excision
30%
27
reverse smoker's palate
diffuse keratosis of the palate significant risk of epithelial dysplasia/carcinoma
28
red patch that cannot be diagnosed as any other condition clinically/microscopically
erythroplakia
29
velvety demarcated patch,
erythroplakia
30
why are erythoplakia's red
red appearance is due to the lack of keratin production on the surface of the lesion
31
____ of erythoplakias are severe epithelial dysplasia or worse at time of biopsy
90%
32
premalignant sun-induced skin lesion
actinic keratosis
33
Places actinic keratosis occurs (3)
facial skin, vermillion zone, lower lip
34
Demographics of actinic keratosis
fair-skinned person >40
35
scaly plaque w/sandpaper texture
actinic keratosis
36
may have erythematous base
actinic keratosis
37
some degree of epithelial dysplasia or even superficially invasive squamous cell carcinoma
actinic keratosis
38
Tx options for actinic keratosis (7)
```
liquid nitrogen
Surgical excision
laser ablation
5-fluoro-uracil (Effudex)
imiquimod (Aldara)
Mohs micrographic surgery
reduce sun exposure
```
39
prognosis of actinic keratosis
fair to good
40
actinic keratosis involving the vermillion zone of the lower lip
actinic cheilitis
41
Clinical features of actinic cheilitis (4)
chronic scaling
crusting
ulceration
fissuring of the lip
42
actinic cheilitis lesions develop ____.
slowly
43
Epithelium of actinic cheilitis may exhibit (3)
hyperkeratosis
acanthosis (thickening)
atrophy
44
basophilic change of CT caused by UV damage
solar elastosis
45
solar elastosis is associated with
actinic cheilitis
46
Tx of actinic cheilitis
```
vermilionectomy
laser ablation of vermillion zone
electrodessication
5-FU
cryotherapy
reduce sun exposure
biopsy/re-biospy
```
47
risk for transformation of actinic cheilitis of SCC is ____ than for actinic keratosis
2.5
48
erythroplakia
usually affecting the lateral tongue, floor of the mouth, or soft palate
49
malignancies of surface epithelial origin (4)
```
basal cell carcinoma
cutaneous squamous cell carcinoma
squamous cell carcinoma of the lip
oral squamous cell carcinoma
verrucous carcinoma
```
50
most common skin cancer
basal cell carcinoma
51
basal cell carcinoma arises from the
basal cells of the epidermis
52
basal cell carcinoma occurs where?
any cutaneous site
80% H/N
*mask
53
occurs in M>F (3)
basal cell carcinoma, OSCC, verrucous carcinoma
54
risk factor tendency for freckling in childhood?
basal cell carcinoma
55
PUVA for psoriasisis
risk factor for basal cell carcinoma
56
tanning beds
risk factor for BCC
57
immunosuppression
risk factor for BCC
58
Types of BCC (6)
```
Nodulo-ulcerative BCC
Pigmented BCC
Sclerosing (morpheaform) BCC
Superficial BCC
BCC associated syndromes
fibroepithelioma
```
59
most common BCC
nodulo-ulcerative BCC
60
least common BCC
sclerosing (morpheaform) BCC
61
firm painless papule
nodulo-ulcerative BCC
62
rolled borders
nodulo-ulcerative BCC
63
central umbilication (depression) often ulcerates
nodulo-ulcerative BCC
64
pearly, opalescent when pressed
nodulo-ulcerative BCC
65
no hair
nodulo-ulcerative BCC
66
telangiectasia
nodulo-ulcerative BCC
67
hx of intermittent bleeding/healing
nodulo-ulcerative BCC
68
uniform, ovoid dark-staining basaloid cells
nodulo-ulcerative BCC
69
basaloid cells appear to drop off
nodulo-ulcerative BCC
70
(2) large lobules of tumor cells
nodulo-ulcerative BCC
| pigmented BCC
71
three descriptors of pigmented BCC
resemble melanocytic nevi, short duration, lack of hair
72
colonization by benign melanocytes
pigmented BCC
73
most aggressive type of BCC
sclerosing (morpheaform) BCC
74
resembles scar
sclerosing (morpheaform) BCC
75
difficult to assess borders
sclerosing (morpheaform) BCC
76
describe histopathologic features of sclerosing BCC
infiltrative nests of tumor cells in collagenous background
77
prognosis of BCC
excellent
78
most common oral malignancy
squamous cell carcinoma
79
2nd most common cutaneous malignancy
squamous cell carcinoma
80
arises from surface epithelium/epidermis
squamous cell carcinoma
81
Type of SCC (3)
1) Squamous cell carcinoma of the lip
2) oral squamous cell carcinoma
3) cutaneous SCC
82
Risk Factors for cutaneous SCC (3)
chronic UV light exposure
medical ionizing radiation
pre-existing actinic keratosis
83
Clinical Features of cutaneous SCC (5)
70% H/N, slow non-healing ulcer, plaque/papule/nodule, variable scale/crust, erythematous base
84
SCC of the lip usually occurs where?
LL
85
RF for SCC of the lip
chronic UV light exposure
86
Describe SCC of the lip (5)
rough, scaly
ulcerated
slow, from acetnic cheilitis
87
histopathology of SCC of the lip?
well-differentiated
88
TX for SCC of the lip (4)
scalpel excision
vermilionectomy
reduce sun exposure
use SPF
89
prognosis for SCC of the lip
good for LL
bad for UL
good if ID early
90
most common oral maligancy
OSCC
91
_____ associated w/tobacco for OSCC
75-80%
92
most common site for OSCC
tongue (posterior/lateral, ventral)
93
Sites for OSCC (6)
```
tongue
floor of mouth
gingiva
labial/buccal mucosa
soft palate
hard palate
```
94
Fe defiency anemia is risk factor for?
OSCC
95
what population is risk factor for OSCC
M>50 years
96
describe lesion for OSCC (6)
pain, exophytic, endophytic, leukoplakia, erytheoleukoplakia, erythoplakia
97
describe endophytic lesion for OSCC
invasive, burrowing, ulcerated
98
describe exophytic lesion for OSCC (4)
mass-forming, fungating, papillary, and verruciform
99
describe radiographic feature of SCC (3)
moth eaten radiolucency
ill defined
pathologic fracture possible
100
Histopatholgic Features of OSCC (3)
* invasive cords/nests of malignant epithelial cells from dysplastic epithelium
* increased N/C ratio, pleomorphism, mitoses
* varying degrees keratin production
101
Tx for OSCC (6)
```
wide surgical excision
radiation therapy
chemotherapy
all/combo above
neoadjuvant therapy
molecular based
```
102
Prognosis for OSCC
poor, most present in stage 3/4
103
in OSCC, ____ of these patients will develop aerodigestive tract maligancies
10-25%
104
uncommon form of SCC, less agressive
verrucous carcinoma
105
SCC assoc. with dry snuff
verrucous carcinoma
106
verrucous carcinoma affects which population?
elderly male (females-dry snuff)
107
verrucous carcinoma affects where? (5)
mandibular buccal vestibule, buccal muocsa, gingiva, tongue, hard palate
108
describe lesion of verrucous carcinoma? (5)
well-defined, painless, thick plaque, papillary verruciorm projectsions, white/erythematous/pink
109
verrucous carcinoma histopathologic features? (3)
wide, pushing rete ridges
rough papillary surface
keratin plugging
110
conventional SCC dev. in ____ of tumors?
20%
111
tx of verrucous carcinoma
surgical excision
112
prognosis of verrucous carcinoma
90% disease free after 5 years
113
name melanocytic lesions (7)
```
ephelis
actinic lentigo
melanotic macule
acquired melanocytic nevus
congenital melanocytic nevus
blue nevus
melanoma
```
114
"freckles"
ephelis (plur. ephelides"
115
ephelides are usually located where?
face, arm, back
116
common, harmless melnanocytic lesions that appear on sun-exposed skin?
actinic lentigo
117
"age spots" or "liver spots"
actinic lentigo
118
clinical marker of UV damage
actinic lentigo
119
don't wax and wane with sun exposure
actinic lentigo
120
actinic lentigo occurs where?
face, dorsum of hands
121
tx for actinic lentigo?
none, unless for esthetic
122
common, harmless lesion w/maximum dimension achieved rapidly then remains constant
melanotic macule
123
etiology of melanotic macule?
unknown etiology
124
population of melanotic macule?
female, 43
125
melanotic macule occurs where?
lip/oral mucosa
126
three descriptors of melanotic macule?
tan to dark brown
| <7mm, demarcated margins
127
three histopathologic features of melanocytic macule?
increased melanin pigmentation along basal epithelial layer
* melanin incontinence
* normal stratified squamous epithelium
128
tx for melanotic macule?
none, unless recent onset/large size, irregular pigmentation, unknown duration
129
prognosis of melanotic macule?
benign, one report of malignant transformation
130
dermatologic term for mole
acquired melanocytic nevus
131
most common of all human tumors
acquired melanocytic nevus
132
population of acquired melanocytic nevus?
childhood, 4th decade, caucasian
133
what gradually involutes with age
acquired melanocytic nevus
134
acquired melanocytic nevus occurs where?
most above the waist
H/N common
skin or mucosa
135
5 features w/acquired melanocytic nevus?
```
macules/papules
sharply demarcated
brown, black, tan, skin-colored
<6mm
hair
```
136
in the oral cavity, where do acquired melanocytic nevus occur? (2)
hard palate
| attached gingiva
137
three stages of acquired melanocytic nevus
junctional stage
compound stage
intradermal stage
138
tx of all unexplained pigmented oral lesions?
excisional biopsy
139
tx for acquired melanocytic nevus?
none for cutaneous nevi
| unless chronically irritated, esthetic concern of changes in size/color
140
prognosis for acquired melanocytic nevus?
low risk of malignant transformation
| 1/3000-10,000
141
how common is congenital melanocytic nevus
1% of newborns
142
congenital melanocytic nevus usually occurs where?
trunk/extremities
| 15% H/N
143
what lesion has hypertrichosis?
congenital melanocytic nevus
144
treatment of congenital melanocytic nevus? (5)
excise for esthetic reasons
| dermabrasion/chemical peel/laser/cryotherapy/partial surgical excision
145
prognosis for congenital melanocytic nevus?
1% for malignant transformation for small-excision
| 2-3% large transform-staged excision
146
where do blue nevus occur cutaneously? (4)
hands, feet, scalp, face
147
where do blue nevi occur mucosally?
oral/conjunctival
148
bluish or blue gray due to depth of melanin pigment
Tyndall effect-blue nevus
149
demographic of blue nevus?
children, young adults, females
150
size of blue nevus?
<1cm macule/papule
151
most common oral site of blue nevus?
palate
152
blue nevus histopathologic features? (3)
* elongated dendritic melanocytes in CT
* abundant melanin pigment
* no atypia
153
tx of blue nevus?
conservative excision
| biopsy all unexplained pigmented oral lesions
154
prognosis of blue nevus
excellent
recurrence rare
malignant transformation rare, but reported
155
third most common skin cancer
melanoma
156
risk factors for melanoma (9)
| shoot for three each time
```
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
clinical features of melanoma
40-70yrs, females <40
male in older
overall mostly males
158
what percent of melanoma are cutaneous sites?
91% cutaneous
159
high risk sites and percentage for melanoma
40/BANS
160
H/N make up what percent of melanoma
25%
161
mucosa makes up what percent of melanoma?
1%
162
Clinical features of melanoma
```
ABCDE
A=assymetry
b=border irregularity
C=color variegation
D: diameter >6mm
E=evolving
```
163
melanoma growth phases?
radial-laterally
| vertical: extends deeper into CT
164
precursor of melanoma?
lentigo maligna
165
clinicopathologic types of melanoma? 4
lentigo maligna melanoma
superficial spreading melanoma
nodular melanoma
acral lentiginous melanoma
166
hutchinson's freckle?
lentigo maligna
167
melanoma in pureply radial growth phase?
melanoma in-situ
168
demographics of lentigo maligna + location ?
older individuals w/fair complexion + facial skin
169
lentigo maligna melanoma what % arise in lentigo maligna?
5%
170
nodularity in previously flat lentigo maligna signals what?
vertical growth phase
| lentigo maligna melanoma
171
what percent of melanoma is superficial spreading?
70%
172
what percent of superficial spreading melanoma is in H/N?
15-20%
173
4 clinical features of superficial spreading melanoma?
interscapular area of Men
back of legs of women
begins as a macule/plaque
classic clinical features (ABCDES)
174
rapidly growing nodule?
nodular melanoma
175
what percent of melanoma is nodular melanoma?
15%
176
what percent of nodular melanoma is H/N
33%
177
describe growth of nodular melanoma?
almost immediate vertical phase if little if any radial growth
178
describe appearance of nodular melanoma? (2)
deeply pigmented
| amelanotic
179
most common form oral melanoma
acral lengtinous
180
what percent of melanoma is acral lentiginous?
8%
181
most common melanoma in persons of color?
acral lentiginous
182
more aggressive form of melanoma over cutaneous?
acral lentiginous
183
sites of acral lentiginous? (4)
palms of hands
soles of feet
subungal
mucous membranes
184
description of acral lentiginous? (3)
dark-color variation
irregular margin
macule which dev. into nodule
185
desciption of oral acral lentiginous?
dark-may see color variation
*amelanotic
*irregular margin
macule which dev. into nodule
186
population of acral lentinigous?
male, 5-7th decade
187
location of oral acral lentinigous?
hard palate/maxillary alveolar mucosa 70%-80%
188
4 clinical features of acral lentigionous?
ulceration/pain/soft to palpation/cervical lymph node metastasis
189
radiographic appearance of acral lentiginous?
irregular radiolucency/mixed lesion
190
tx of melanoma?
surgical excision 1-2cm margin for cutaneous
* lymph node dissection
* genotype-directed immunotherapy
191
prognosis of melanoma
depth of invasion
<0.75mm-96% 10 year survival
>3.6 mm- 26% 10 year survival
better prognosis for younger than 50, F
192
where is prognosis for melanoma worse?
worse for cutaneous on trunk, H/N (esp scalp/neck)
| worse for mucosal than cutaneous
193
what is the prognosis for oral melanoma?
5 year survival rate 10-25%
difficult achieving wide surgical margin s
*early metastasis
194
routes of metastasis for melnaoma
lymphatics
blood
brain/liver/bone
195
M>50 (two conditions)
leukoplakia, OSCC
196
80% of leukoplakia show what
hyperkeratosis without epithelial dysplasia
