Premalignant Epithelial Lesions Flashcards
T/F: Leukoplakia is a diagnosis.
False
Clinical finding
What is the most common oral precancerous lesion?
Leukoplakia
T/F: A biopsy is mandatory when leukoplakia is seen.
True
What causes the white color involved with leukoplakia?
Thickened keratin in a moist environment
T/F: Ill-fitting dentures, poor oral hygiene, and broken teeth increase a patients risk for oral cancer.
False
T/F: Moderate alcohol use by itself is a risk factor for oral cancer.
False
Strong synergism with tobacco
What differentiates frictional keratosis from leukoplakia?
Blended borders with frictional keratosis
T/F: Nicotine stomatitis is precancerous.
False
Due to heat
What is the most common form of candidiasis?
Erythematous candidiasis
How do you differentiate leukoedema from tobacco pouch keratosis?
Tobacco pouch keratosis does not disappear when stretched
T/F: Gingival recession and loss of buccal bone can be associated with tobacco pouch keratosis.
True
What causes the gray, translucent appearance in tobacco pouch keratosis?
Contact irritation - cessation of the habit will resolve lesion within 5-6 weeks
Patient stops using smokeless tobacco for 5-6 weeks but leukoplakia is still seen at reevaluation. What to do?
Biopsy
T/F: Smokeless tobacco is a bigger risk for cancer than cigarette smoking.
False
Smokeless tobacco has significantly less risk than cigarettes
How is epithelial dysplasia graded?
Microscopic analysis:
Mild - lower 1/3
Moderate - lower 1/2
Severe - upper 1/3
Carcinoma in-situ - full thickness of epithelium
What are some histopathological features of leukoplakia?
Keratosis, often sharp transition from affected to normal
What percentage of leukoplakias show hyperkeratosis without epithelial dysplasia?
80% of leukoplakias show hyperkeratosis without epithelial dysplasia
What happens to the rete ridges of epithelium as dysplasia progresses?
They become more bulbous and coalescent
What percentage of patients with leukoplakia are smokers?
80% of patients with leukoplakia are smokers
T/F: Brush biopsy is just as useful as scalpel biopsy.
False
How do you calculate pk/yr TOB?
(Number of packs of cigarettes per day) x (number of years smoked)
Ex. Patient smokes 2 packs per day for 10 years = 20 pk/yr TOB
What is the most definitive clinical feature of a leukoplakia?
Sharply demarcated, crisp borders
What is the most common site for leukoplakia?
Buccal mucosa
What is another term for erythroleukoplakia?
Speckled leukoplakia
What is the clinical appearance of an erythroleukoplakia?
Red and white components
T/F: An erythroleukoplakia is more severe than a leukoplakia.
True
What is the prognosis for a leukoplakia?
Guarded
15% non-dysplastic lesions will transform to SCC if not treated
33% dysplastic lesions will transform
30% will recur even after complete clinical excision
What are some definitive features of proliferative verrucous leukoplakia (PVL)?
Grows laterally; slow, persistent spreading
Will involve multiple sites
“Warty” rough projections
T/F: PVL is seen mostly in females and has less association with smoking.
True
PVL will often transform to squamous cell carcinoma within _______ years.
8
T/F: Erythroplakia is has a worse prognosis than leukoplakia.
True
T/F: Erythroplakia is more prevalent in men.
False
Unlike leukoplakia, Erythroplakia has no gender predilection
What are the most common sites of Erythroplakia?
Lateral tongue, floor of mouth, soft palate
What are the clinical features of Erythroplakia?
Well demarcated, velvety red patches
What percentage of Erythroplakia show severe epithelial dysplasia or worse at the time of biopsy?
90%
What are the highest risk sites for leukoplakia?
Ventral tongue, floor of mouth, soft palate/tonsillar pillars
What is a major risk factor for oral submucous fibrosis?
Betel quid, paan, masala, gutkha, mawa
*Indian subcontinent, Southeast Asia, etc.
What are the clinical features of oral submucous fibrosis?
Pallor and fibrosis (white color) to soft palate with the uvula retaining normal color
*burning and intolerance to spicy foods, limited incisal opening
T/F: Oral submucous fibrosis will regress with habit cessation.
False
T/F: Actinic keratosis is caused by UV rays.
True
A light skinned 51 yr old male has a scaly plaque with sandpaper texture on his forehead. Likely diagnosis?
Actinic keratosis
What is likely seen histopathologically with actinic keratosis?
Hyperkeratosis, solar elastosis, epithelial dysplasia
What is the term for actinic keratosis involving the vermilion zone of lips?
Actinic cheilitis
Who is the most likely to get actinic cheilitis?
male over 45 with fair skin
What are some major clinical features of actinic cheilitis?
Dryness, fissures, blended vermillion border
Dry portions may thicken and become leukoplakias
T/F: Hyperkeratosis may be seen in actinic cheilitis and actinic keratosis.
True
T/F: Actinic cheilitis is more likely to become cancer than actinic keratosis.
True
T/F: Actinic cheilitis has a better prognosis than intraoral SCC.
True
