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Oral Pathology Exam 1 > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

4 common locations for oral melanotic macules

A

Vermillion border of lower lip
Bucal mucosa
Mx anterior gingiva
Palate

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2
Q

5 common places to see racial pigmentation

A 
Gingiva
Buccal mucosa
Lips
Palate
Tongue
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3
Q

Tx for melasma

A

Topical cream with:
4% hydroquinone
.05% tretinoin
.01% fluocinolone acetonide

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4
Q

Incidence of melasma

A

Pregnancy
V rare in men
Face of Asian or Hispanic women

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5
Q

Etiology of oral melanoacanthoma

A

Acquired

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6
Q

Clinical presentation of oral melanoacanthoma

A

Fast growing lesion in buccal mucosa

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7
Q

Etiology of oral melanotic macules

A

Increased melanin in basal cell layer + superficial CT WITHOUT melanocytic activity

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8
Q

Incidence of smoker’s melanosis

A

Heavy smokers

Japan - kids of heavy smokers

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9
Q

What is melasma

A

Symmetric diffuse hyperpigmentation of sun exposed skin

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10
Q

Incidence of ephelis (ephelides)

A

Fair haired
NO gender predilection
Genetic
1st decade (less prominent in adults)

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11
Q

Carcinoma of the Mx sinus is (weakly) assoc with

A

Tobacco

Nasal polyps

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12
Q

Is staging or grading of oral SCC done first?

A
  1. Staging

2. Grading (histology)

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13
Q

⅓ of oral melanoma pts have ____ in the area

A

Macule

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14
Q

Ephelis (ephelides)

A

aka freckles

Hyperpigmented macule caused by increased melanin WITHOUT defect in melanocytes

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15
Q

Risk of malignant transformation -oral melanoacanthoma

A

NONE - benign

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16
Q

Rank the common sites of oral SCC in terms of their overall 5 year survival estimates

A

Lip - 88% (best)
Tongue + oropharynx - 65%
Floor of mouth - 54% (worst)

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17
Q

6 risk groups/factors for basal cell carcinoma

A
  1. UV exposure (incl. freckles in childhood)
  2. Psoriasis therapy (psoralen, UV A)
  3. Ionizing radiation exposure
  4. Immunosuppression
  5. Arsenic ingestion
  6. Genodermatoses (Gorlin syndrome, xenoderma pigmentosum, albinism)
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18
Q

Solar lentigo - malignant transformation potential

A

NONE

But - presence of lesions indicate sun damage = pt might be at higher skin cancer risk

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19
Q

Psoralen + UV A are used to treat ______ and is associated with a higher risk for _____

A

Psoriasis therapy

Basal cell carcinoma

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20
Q

Melanoma is the ____ most common skin cancer

A

3rd

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21
Q

2 risk factors for verrucous carcinoma

A

Smoking

HPV (possibly)

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22
Q

Smokers melanosis develops in heavy smokers because melanin plays a role in ______

A

Melanin plays a role in the detoxification of nicotine + benzopyrene

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23
Q

Ephelis (ephelides) has a genetic predilection - assoc with what gene

A

Melanocortin-1-receptor gene

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24
Q

Oral SCC treatment depends on what?

A

Clinical stage

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25
Q

Does solar lentigo change after UV exposure like freckles?

A

No

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26
Q

What are the 4 reasons why verrucous carcinoma as a good prognosis?

A

Slow growing
Well differentiated
Minimal/no dysplasia
Rarely metastasizes

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27
Q

3 common locations for oral melanocytic nevi

A

Palate
Mucobuccal fold
Gingiva

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28
Q

For cancers of the oral cavity + lip, a higher stage is associated with a dramatic drop in 5 year survival rates. Why is this not the case with cancers of the oropharynx?

A

Survival rates are better bc of the increasing incidence of HPV related cases

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29
Q

Most common cancer

A

Basal cell carcinoma

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30
Q

Give 2 examples of targeted + immunomodulatory therapy used to tx oral SCC

A

Monoclonal antibodies

Tyrosine kinase inhibitors

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31
Q

SCC tumors in lower lip +/or floor of mouth mets via…

A

Submental nodes

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32
Q

Why are DDS/DHs the most important people in fight to improve survivability of oral cancer

A

Early detection (@ dysplasia stage) is most effective means of saving lives

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33
Q

Oral SCC distantly mets (below clavicle) common locations (3)

*only happens in 2% of cases

A

Lung
Liver
Bones

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34
Q

Incidence of oral melanotic macules

A

Women 2x> men

5th decade

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35
Q

What determines the grade of oral SCC?

A

Histology

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36
Q

Clinical appearance of lentigo simplex

A 
Single or multiple
Any surface (even if not sun exposed)
Small
Uniform
Tan to brown/black
37
Q

In women, smokers melanosis is assoc with

A

Synergistic effect of hormones

38
Q

List 3 examples of the platinum-containing cheotherapeutic drugs commonly used to treat oral SCC

A

Cisplatin
5-fluouracil
Taxanes

39
Q

SCC tumors of the posterior mouth mets via…

A

Superior jugular nodes

Digastric nodes

40
Q

Does lentigo simplex have malignant transformation potential?

A

No

41
Q

Metastasis of oral SCC goes through ______ to _____

A

Lymphatics to the IPSILATERAL cervical lymph nodes

42
Q

Incidence of oral melanoma

A

<1% all melanomas

More common in other countries (Japan)

43
Q

3 reasons why oral SCC dx might be delayed

A
  1. Some regions (i.e. base of tongue) often go undetected until late stage
  2. Majority of dentists don’t do oral cancer screen at routine visits
  3. Sometimes an adult w neck node gets Rx antibiotics (delays dx)
44
Q

Prognosis of oral melanoma

A

POOR

5 yr survival = 45%
10 yr = 28%

45
Q

What country has the highest rates of BCC?

A

Austrailia

46
Q

Are oral melanocytic nevi acquired or congenital?

A

Acquired

RARELY congenital

47
Q

Solar (actinic) lentigo is a result of _____ caused by ______

A

Melanocytic hyperplasia caused by UV exposure

48
Q

5 common locations to see smoker’s melanosis

A 
Anterior facial gingiva
Floor of mouth
Buccal mucosa
Lips
Hard palate
49
Q

Incidence of oral melanoacanthoma

A

UNCOMMON
Almost exclusively Black
Female predilection

50
Q

Basal cell carcinoma is associated with mutations in _________, which is involved in _______

A

Patched gene

Involved in the sonic hedgehog pathway

51
Q

TNM staging ONLY applies to which cancers?

A

HPV negative

52
Q

Where do you typically see smoker’s melanosis in:

Cigarette smokers
Pipe smokers
Reverse smokers

A

Cigs - gingiva
Pipe - buccal mucosa, commissures
Reverse - hard palate

53
Q

BCC is ____ invasive and ____ spreading

A

Locally invasive

Slow spreading

54
Q

Incidence of BCC in North America

A

Increase recently in aging population + young women

55
Q

Lentigo simplex might be a precursor to…

A

Melanocytic nevi

56
Q

Racial pigmentation can present in ____ papillae

A

Fungiform papillae

57
Q

What are 9 clinical prognostic factors for cases of oral SCC (predict how the pt will fxn post-tx)

A
  1. Performance status + comorbidities
  2. Primary site of disease
  3. Tumor stage
  4. Depth of invasion
  5. Nodal stage
  6. Total tumor burden
  7. Post-surgical margin
  8. Histological grade
  9. Response to chemo
58
Q

How do oral melanotic macules differ when they are intraoral vs. labial

A

Intraoral macules are larger than labial macules

59
Q

How can you differentiate between racial pigmentation and a pathologic process

A

Racial pigmentation is usually diffuse + bilateral

60
Q

7 risk factors for recurrence of BCC

A
  1. Lesion 6mm(+) in ‘mask area’ of face
  2. Lesion 1cm(+) outside ‘mask area’
  3. Ill defined borders
  4. Micronodular, infiltrative, sclerosing types
  5. Perineural invasial
  6. Recurrent lesions
  7. Immunosupporessed pts or sites of radiation tx
61
Q

Carcinoma of the Mx sinus can extend to _____

A

Palate

62
Q

Lentiginosis profusa
Peutz Jeghers
LEOPARD
Xeroderma pigmentosum

These are rare syndromes associated with…

A

Multiple lentigo simplex lesions

63
Q

What do metastatic (cervical) lymph nodes feel like upon palpation?

A

Firm

Feel ‘fixed’

64
Q

Oropharyngeal SCC tumors mets via…

A

Jugulodigastric nodes

Retropharyngeal nodes

65
Q

Which skin cancer causes the most deaths

A

Melanoma

66
Q

Lentigo simplex lesions are typically _____ than solar lentigo lesions - is the color intensity related to sun exposure?

A

Darker

Color intensity are NOT related to sun exposure

67
Q

Overall survival of oral SCC patients falls by _____ from stage I/II to stage III/IV, making early dx critical

A

Half

68
Q

What 4 things can cause lesions that are similar to melasma?

A

Oral contraceptives
Hormone replacement therapy
Thyroid disorders
Certain drugs + cosmetics

69
Q

Oral melanoma makes up ___% of all melanomas

A

<1% of all melanomas

70
Q

Carcinoma of the Mx sinus mimics…

A

The inflammatory process

71
Q

4 types of melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentigenous

72
Q

Does melanoma always have a premalignant lesion?

A

No

Can be from benign melanocytic lesion or de novo

73
Q

Solar lentigo clinical appearance

A 
On face (not in mouth)
.5-1 cm
Sharply circumscribed
Single or multiple
No change after sun exposure
74
Q

Verrucous carcinoma can present basically anywhere in the OC - what are the 5 most common sites (in order)

A
  1. Md vestible
  2. Buccal mucosa
  3. Gingiva
  4. Tongue
  5. Palate
75
Q

Incidence of basal cell carcinoma (in general)

A 
White
>40 yrs
Fair complexion
Red + blonde hair
Blue/green eyes
Men > women
76
Q

Chemotherapeutic drugs used to treat oral SCC contain ______

A

Platinum

77
Q

Oral melanoma is ______ than cutaneous melanoma

A

More aggressive

78
Q

Clinical appearance of ephelis (ephelides)

A

Small
Uniform color
NOT as dark as lentigo simplex
More pronounced post-sun

79
Q

Gorlin syndrome

A

aka nevoid basal cell cercinoma syndrome

Genodermatoses (genetic skin disorder) associated with basal cell carcinoma

80
Q

Basal cell carcinoma arises from

A

Basal cells

81
Q

Nasopharyngeal carcinoma is usually associated with an environmental causing agent. List 3 examples

A

Epstein Barre Virus
Low vitamin C
Salt fish

82
Q

Lentigo simplex, like solar lentigo, is a result of

A

Melanocytic hyperplasia

83
Q

Where do you see lentigo simplex lesions

A

Any skin surface

Including skin not exposed to sun

84
Q

Common sites for oral melanoma

A

Hard palate

Mx alveolus

85
Q

Melasma occurs usually in pregnancy bc ______

A

Estrogen + progesterone play a role

86
Q

3 different clinical types of BCC

A

Noduloulcerative (nodular)
Pigmented
Sclerosing

87
Q

Most common skin cancer

A

Basal cell carcinoma

88
Q

SNUC, adenoca, SCCa, neuroendocrine are different types of…

A

Carcinoma of the mx sinus

89
Q

Metastatic lymph nodes feel fixed bc…

A

Tumor has spread outside capsule

Oral Pathology Exam 1 (3 decks)

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