Premalignant & Malignant Lesions

Question 1

Premalignant (potentially malignant) lesions

Answer 1

Benign, morphologically-altered tissue with greater than normal risk of malignant transformation

Question 2

Malignant transformation potential

Answer 2

Risk of cancer being present in a premalignant lesions, at initial diagnosis or the future

Question 3

Cervical intraepithelial neoplasia

Answer 3

Premalignant lesion of the uterus, which shows 20% malignant transformation potential

Question 4

conclusion

Answer 4

cancer is often preceded by premalignant lesions

careful examination needed for diagnosis

oral cancer mortality have remained steady

dentists have a critical role in improving rates

Question 5

Answer 5

Leukoplakia

White patch that cannot be clinically or pathologically diagnosed as any other condition

Represents 85% of all premalignant lesions

33% of cancers have leukoplakia around

80% of patients are smokers, smokers > non-smokers, heavy > light, may resolve after cessation

more common in males >40 years, average age of pt is 60

70% occur in lip vermillion, buccal mucosa and gingiva. Those in tongue and floor of mouth more likely to be dysplastic/malignant

Question 6

starts in gingiva, progressive growth, eventually transforms in cancer

Answer 6

Proliferative verrucous leukoplakia

Question 7

Red patch that cannot be clinically or pathologically diagnosed as any other condition

Same risk factors as oral cancer

Less common than leukoplakiam but greater malignant potential

Answer 7

Erythroplakia

Question 8

Answer 8

Erythroplakia

well-demarcated macule/plaque, with velvety texture

Question 9

Answer 9

Erythroplakia

Common in floor of mouth, tongue and palate (soft)

Question 10

Answer 10

Erythroleukoplakia

association of erythroplakia and leukoplakia

90% show severe dysplasia, carcinoma in situ or invasive cancer on biopsy

Question 11

Types of smokeless tobacco (aka “spit tobacco”)

chewing tobacco (loose leaf), moist snuff (dipping), dry snuff

Answer 11

smokeless tobacco keratosis

Question 12

Answer 12

Moist snuff

usually place in the vestibule

Question 13

Answer 13

smokeless tobacco keratosis

caries, gingival recession and halitosis

Question 14

Answer 14

smokeless tobacco keratosis

lesions can become thicker and appear leathery or nodular

Question 15

seen mostly in indian subcontinent, southeast Asia, Taiwan, South China and New Guinea

Associated w/ use of betel quid or paan

Wrap or areca tree nut and lime, usually with tobacco

trismus is usually chied complaint

Answer 15

Oral submucous fibrosis

Question 16

Answer 16

Oral submucous fibrosis

Betel chewer’s mucosa: brown/red incrustations (not precancerous)

Question 17

Answer 17

Oral submucous fibrosis

pallor and fibrosis of the soft palate (“marble-like pallor”)

Question 18

long-term exposure to UV, fair skin, tendency to sun burn, 10x more in males, patients >45 yo

slow development, atrophy of vermillion borer, smooth surface and paleness, blurring of vermillion margin

rough, scaly areas develop, leukoplakia areas appear, scaly material, multifocal ulcers develop

6% malignant transformation potential

Answer 18

Actinic cheilitis

Question 19

80% of pts are smokers, 8x increased risk, risk of secondary carcinomas, 30% of pts are drinkers, 20% have cirrhosis, 15x risk (+ cigarette)

Answer 19

Squamous cell carcinoma

Question 20

due to UV damage

70% pts outdoor occupation

90% lower lip

metastases are rare

Answer 20

squamous cell carcinoma of the lip