Premalignant lesions Flashcards
what is the definition of Leukoplakia?
White patch of the oral mucosa that cannot be scraped off and cannot be diagnosed clinically as any other condition
T/F: Leukoplakia that persists or progresses must be biopsied
true
what are some differential diagnoses for leukoplakia?
Leukoedema Cheek chewing Frictional keratosis Nicotine stomatitis Smokeless tobacco keratosis Aspirin burn Candidiasis Lichen planus White sponge nevus Cinnamon reaction
what population groups are at the highest risk for leukoplakia?
Older adult males (>40 years of age) Tobacco use (cigarettes), UV exposure
leukoplakia is most commonly found in what sites in the oral cavity?
lip vermilion (UV), buccal mucosa, gingiva (70%)
leukoplakias in what areas of the mouth have the highest risk for dysplasia?
tongue, floor of mouth, lip vermilion
name the clinical features of a leukoplakia lesion
Sharply-demarcated (well-defined) white plaque with variable surface (smooth, wrinkled, micronodular)
if there is a red component in a leukoplakia lesion, what is it called?
“speckled leukoplakia”
erythroleukoplakia
name the Histological characteristics of leukoplakia
A) Hyperkeratosis (wet keratin appears white)
B) Abrupt transition from normal epithelium
C) Precancerous (dysplastic) change or carcinoma (5-25%; average of ~10%)
what is the treatment for leukoplakia?
Treatment is controversial
For no dysplasia or mild dysplasia - D/C carcinogenic habits; watch?
For moderate dysplasia or worse - remove by the most convenient means available
describe the prognosis for leukoplakia:
what will transform, what % will recur
Prognosis is guarded
15% of non-dysplastic lesions will transform if not treated
33% of dysplastic lesions will transform
30% of leukoplakias will recur
____________ is defined as “A red patch that cannot be diagnosed as any other condition clinically”
Erythroplakia
T/F: Erythroplakia is less serious than leukoplakia, but has the same epidemiologic features and risk factors
FALSE
Erythroplakia is more serious
what are the clinical characteristics of Erythroplakia? what areas of the mouth does it affect?
Velvety red, well-demarcated patch
usually affecting the lateral tongue, floor of the mouth or soft palate
Microscopically, __%of Erythroplakia lesions are severe epithelial dysplasia or worse at the time of biopsy
90%
what causes the red appearance of Erythroplakia lesions?
due to the lack of keratin production on the surface of the lesion
T/F: When initially diagnosed, most erythroplakia lesions are higher grade lesions than leukoplakia lesions
true
what is the definition of Actinic (solar) Keratosis?
what is its clinical appearance?
Premalignant sun-induced skin lesion caused by chronic UV exposure
Scaly plaque with reddish base and sandpaper texture
where are Actinic (solar) Keratosis lesions usually found?
what population group do they usually effect?
Common on facial skin and vermilion zone of the lower lip in fair-skinned persons over 40 years of age
describe the histological findings of Actinic Keratosis:
Hyperkeratosis (white) and epithelial atrophy (reddish)
Some degree of epithelial dysplasia or carcinoma-in-situ (by definition)
Actinic (solar) keratosis lesions generally give rise to what type of cancer?
Gives rise to invasive squamous cell carcinoma
how are Actinic keratosis lesions treated?
Skin lesions treated with topical liquid nitrogen, surgical excision, laser ablation, 5-fluorouracil (5-FU, Effudex) or imiquimod (Aldara)
T/F: Patients that have had actinic keratosis must be continually monitored for new lesions
true
what is Actinic Cheilosis (Cheilitis)?
Term for actinic keratosis involving the vermilion zone of the lower lip
what is the clinical presentation for Actinic Cheilitis (cheilosis)?
Chronic scaling, ulceration, atrophy and/or fissuring of the lip
how are Actinic Cheilitis lesions treated?
1) Vermilionectomy with advancement of the labial mucosa or laser ablation of the involved vermilion zone
2) 5-FU and imiquimod in selected cases
3) Patients should use sun block/sun avoidance with long term follow-up
