Premalignant, Malignant and Melanocytic Lesions Flashcards
Sharply demarcated white patch of the oral mucosa that cannot be wiped off AND cannot be diagnosed clinically as any other condition.
Leukoplakia
What is the most common site for Leukoplakia?
buccal mucosa
What is the worldwide prevalence of leukoplakia?
1.5-4.3%
What are the high risk sites for Leukoplakia?
Ventral tongue, floor of mouth, soft palate/ tonsillar pillars
___% of non-dysplastic leukoplakia will transform if not treated.
15%
___% of dysplastic leukoplakia will transform
33%
__% of leukoplakia will recur (even after complete clinical excision)
30%
Leukoplakia which grows laterally and involves multiple sites
Proliferative verrucous leukoplakia (PVL)
Velvety well-demarcated asymptomatic red patch that cannot be diagnosed as any other condition clinically or microscopically
Erythroplakia
Soft palate gets white and feels like “piano wires”; may cause limitation upon opening
Oral submucous fibrosis
Premalignant sun-induced skin lesion; scaly plaque with sandpaper texture with/without an erythematous base
Actinic keratosis
Chronic scaling, crusting and ulceration or fissuring of the lip from UV damage. May also have vertical dermatoglyphics or atrophy of vermillion zone.
Actinic cheilitis
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.
Tobacco Pouch Keratosis
Most common skin cancer
Basal Cell Carcinoma
2nd most common skin cancer
Squamous cell carcinoma
3rd most common skin cancer
Melanoma
Most common oral malignancy
Oral squamous cell carcinoma
Firm, pearly, opalescent painless papule with central umbilication- ulcerates and can bleed, intermittently- pt may think they scratched or shaved over it.
Nodulo-ulcerative BCC
Uniform dark staining basaloid cells that appear to “drop off”. Large lobules of tumor cells
Nodulo-ulcerative BCC
Large lobules of tumor cells invading the superficial CT with colonization of benign melanocytes causing a pigmented lesion.
Pigmented BCC
Lesion feels firm and resembles a scar due to induction of collagen formation by tumor cells- difficult to assess borders. Most aggressive form.
Sclerosing (morpheaform) BCC
Tiny infiltrative nests of tumor cells in a collagenous background
Sclerosing (morpheaform) BCC
What % of Basal Cell Carcinomas appear on the head & neck region and what is the high risk area?
80%; middle 1/3 of the face or “mask area”
Where does squamous cell carcinoma arise from?
Surface epithelium/ epidermis but on rare occasions- salivary ductal epithelium
Where does basal cell carcinoma arise from?
basal cells of the epidermis
What % of cutaneous squamous cell carcinomas appear on the head & neck region?
70%
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.)
Cutaneous Squamous cell carcinoma
Rough, scaly, often ulcerated, slow growing; arises in setting of actinic cheilitis.
Squamous cell carcinoma of the lip
What % of oral squamous cell carcinomas (OSCC) are associated with tobacco use?
75-80%
What % of oral squamous cell carcinomas (OSCC) are not associated with any identifiable risk factors?
25%
What is the most common site for oral squamous cell carcinomas (OSCC)?
Tongue (esp. posterior/ventral/lateral)
What are the differential diagnoses for oral squamous cell carcinomas (OSCC)?
Non-specific ulcer Specific infections (TB, syphilis, histoplasmosis); Immune-mediated (Wegener's granulomatosis, Crohn's )
Little islands and nests of malignant epithelial cells arising from the dysplastic epithelium.
Oral squamous cell carcinomas (OSCC)
Intrinsic risk factors for oral squamous cell carcinomas (OSCC)
Malnutrition
Iron deficiency anemia
Immunosuppression
Pack/ year TOB equation
(#packs of cigarettes/day) x (# of years smoked)
dermatologic term for “freckles”
Ephelis (pl: ephelides)
harmless melanocytic macular lesions that appear on sun-exposed skin “age spots” or “liver spots”
Actinic lentigo (pl: lentigines)
<7mm demarcated macule on the lip or oral mucosa- female predilection
Melanotic macule
Most common of all human “tumors”
Acquired Melanocytic Nevus
Risk for malignant transformation from an individual cutaneous nevus to melanoma.
1 in 3,000-10,000
Very large “bathing trunk nevus” or “garment nevus” in 1% of newborns.
Congenital Melanocytic Nevus
Bluish-gray <1cm macule or papule seen cutaneously (hands, feet, scalp, face) or intraorally usually in children or young adults.
Blue Nevus
dendritic melanocytes running parallel to the surface
Blue Nevus
What % of skin cancer deaths are due to melanoma?
75%- the 3rd most common skin cancer but the most deaths happen because of it
What are the high risk sites for melanoma?
BANS- back, arms, neck, scalp
large macular lesion with irregular borders and uneven pigmentation- melanoma in a purely radial growth phase (melanoma-in-situ)
Lentigo Maligna “Hutchinson’s freckle”
When a previously flat lentigo maligna becomes nodular signaling vertical growth (~15 years)
Lentigo Maligna Melanoma
A macule or plaque that begins to exhibit classic clinical features (ABCDE’s)
Superficial Spreading Melanoma (15-20% H&N)
A rapidly growing, deeply pigmented nodule- almost immediate vertical phase.
Nodular Melanoma (33% H&N)
Most common form of oral melanoma; more aggressive than cutaneous.
Acral Lentiginous Melanoma
Most common site for an acral lentiginous melanoma
Hard palate/ maxillary alveolar mucosa
What is the prognosis & 5 year survivial for oral melanoma?
POOR; 5- year survival ~10-25%
What is the most common oral site of a blue nevus?
Palate
Where does Sanguinaria primarily affect?
Maxillary buccal gingiva and vestibule
What % of leukoplakias show hyperkeratosis without epithelial dysplasia?
80%
