Premalignant, Malignant and Melanocytic Lesions

Question 1

Sharply demarcated white patch of the oral mucosa that cannot be wiped off AND cannot be diagnosed clinically as any other condition.

Answer 1

Leukoplakia

Question 2

What is the most common site for Leukoplakia?

Answer 2

buccal mucosa

Question 3

What is the worldwide prevalence of leukoplakia?

Answer 3

1.5-4.3%

Question 4

What are the high risk sites for Leukoplakia?

Answer 4

Ventral tongue, floor of mouth, soft palate/ tonsillar pillars

Question 5

___% of non-dysplastic leukoplakia will transform if not treated.

Answer 5

15%

Question 6

___% of dysplastic leukoplakia will transform

Answer 6

33%

Question 7

__% of leukoplakia will recur (even after complete clinical excision)

Answer 7

30%

Question 8

Leukoplakia which grows laterally and involves multiple sites

Answer 8

Proliferative verrucous leukoplakia (PVL)

Question 9

Velvety well-demarcated asymptomatic red patch that cannot be diagnosed as any other condition clinically or microscopically

Answer 9

Erythroplakia

Question 10

Soft palate gets white and feels like “piano wires”; may cause limitation upon opening

Answer 10

Oral submucous fibrosis

Question 11

Premalignant sun-induced skin lesion; scaly plaque with sandpaper texture with/without an erythematous base

Answer 11

Actinic keratosis

Question 12

Chronic scaling, crusting and ulceration or fissuring of the lip from UV damage. May also have vertical dermatoglyphics or atrophy of vermillion zone.

Answer 12

Actinic cheilitis

Question 13

White or gray corrugated tissue that does not disappear when stretched. A “pouch” may be noted and can either be thin and translucent or thick and white.

Answer 13

Tobacco Pouch Keratosis

Question 14

Most common skin cancer

Answer 14

Basal Cell Carcinoma

Question 15

2nd most common skin cancer

Answer 15

Squamous cell carcinoma

Question 16

3rd most common skin cancer

Answer 16

Melanoma

Question 17

Most common oral malignancy

Answer 17

Oral squamous cell carcinoma

Question 18

Firm, pearly, opalescent painless papule with central umbilication- ulcerates and can bleed, intermittently- pt may think they scratched or shaved over it.

Answer 18

Nodulo-ulcerative BCC

Question 19

Uniform dark staining basaloid cells that appear to “drop off”. Large lobules of tumor cells

Answer 19

Nodulo-ulcerative BCC

Question 20

Large lobules of tumor cells invading the superficial CT with colonization of benign melanocytes causing a pigmented lesion.

Answer 20

Pigmented BCC

Question 21

Lesion feels firm and resembles a scar due to induction of collagen formation by tumor cells- difficult to assess borders. Most aggressive form.

Answer 21

Sclerosing (morpheaform) BCC

Question 22

Tiny infiltrative nests of tumor cells in a collagenous background

Answer 22

Sclerosing (morpheaform) BCC

Question 23

What % of Basal Cell Carcinomas appear on the head & neck region and what is the high risk area?

Answer 23

80%; middle 1/3 of the face or “mask area”

Question 24

Where does squamous cell carcinoma arise from?

Answer 24

Surface epithelium/ epidermis but on rare occasions- salivary ductal epithelium

Question 25

Where does basal cell carcinoma arise from?

Answer 25

basal cells of the epidermis

Question 26

What % of cutaneous squamous cell carcinomas appear on the head & neck region?

Answer 26

70%

Question 27

Plaque, papule or nodule with variable degrees of scale on crust; non-healing ulcer, often with an erythematous base located on the skin. (Well-differentiated histologically.)

Answer 27

Cutaneous Squamous cell carcinoma

Question 28

Rough, scaly, often ulcerated, slow growing; arises in setting of actinic cheilitis.

Answer 28

Squamous cell carcinoma of the lip

Question 29

What % of oral squamous cell carcinomas (OSCC) are associated with tobacco use?

Answer 29

75-80%

Question 30

What % of oral squamous cell carcinomas (OSCC) are not associated with any identifiable risk factors?

Answer 30

25%

Question 31

What is the most common site for oral squamous cell carcinomas (OSCC)?

Answer 31

Tongue (esp. posterior/ventral/lateral)

Question 32

What are the differential diagnoses for oral squamous cell carcinomas (OSCC)?

Answer 32

``` Non-specific ulcer Specific infections (TB, syphilis, histoplasmosis); Immune-mediated (Wegener's granulomatosis, Crohn's ) ```

Question 33

Little islands and nests of malignant epithelial cells arising from the dysplastic epithelium.

Answer 33

Oral squamous cell carcinomas (OSCC)

Question 34

Intrinsic risk factors for oral squamous cell carcinomas (OSCC)

Answer 34

Malnutrition Iron deficiency anemia Immunosuppression

Question 35

Pack/ year TOB equation

Answer 35

(#packs of cigarettes/day) x (# of years smoked)

Question 36

dermatologic term for "freckles"

Answer 36

Ephelis (pl: ephelides)

Question 37

harmless melanocytic macular lesions that appear on sun-exposed skin "age spots" or "liver spots"

Answer 37

Actinic lentigo (pl: lentigines)

Question 38

<7mm demarcated macule on the lip or oral mucosa- female predilection

Answer 38

Melanotic macule

Question 39

Most common of all human "tumors"

Answer 39

Acquired Melanocytic Nevus

Question 40

Risk for malignant transformation from an individual cutaneous nevus to melanoma.

Answer 40

1 in 3,000-10,000

Question 41

Very large "bathing trunk nevus" or "garment nevus" in 1% of newborns.

Answer 41

Congenital Melanocytic Nevus

Question 42

Bluish-gray <1cm macule or papule seen cutaneously (hands, feet, scalp, face) or intraorally usually in children or young adults.

Answer 42

Blue Nevus

Question 43

dendritic melanocytes running parallel to the surface

Answer 43

Blue Nevus

Question 44

What % of skin cancer deaths are due to melanoma?

Answer 44

75%- the 3rd most common skin cancer but the most deaths happen because of it

Question 45

What are the high risk sites for melanoma?

Answer 45

BANS- back, arms, neck, scalp

Question 46

large macular lesion with irregular borders and uneven pigmentation- melanoma in a purely radial growth phase (melanoma-in-situ)

Answer 46

Lentigo Maligna "Hutchinson's freckle"

Question 47

When a previously flat lentigo maligna becomes nodular signaling vertical growth (~15 years)

Answer 47

Lentigo Maligna Melanoma

Question 48

A macule or plaque that begins to exhibit classic clinical features (ABCDE's)

Answer 48

Superficial Spreading Melanoma (15-20% H&N)

Question 49

A rapidly growing, deeply pigmented nodule- almost immediate vertical phase.

Answer 49

Nodular Melanoma (33% H&N)

Question 50

Most common form of oral melanoma; more aggressive than cutaneous.

Answer 50

Acral Lentiginous Melanoma

Question 51

Most common site for an acral lentiginous melanoma

Answer 51

Hard palate/ maxillary alveolar mucosa

Question 52

What is the prognosis & 5 year survivial for oral melanoma?

Answer 52

POOR; 5- year survival ~10-25%

Question 53

What is the most common oral site of a blue nevus?

Answer 53

Palate

Question 54

Where does Sanguinaria primarily affect?

Answer 54

Maxillary buccal gingiva and vestibule

Question 55

What % of leukoplakias show hyperkeratosis without epithelial dysplasia?

Answer 55

80%