red and pigmented soft tissue lesions

Question 1

clinical presentation of oral melanotic macule

Answer 1

painless flat brown patches, usually evenly pigmented, less than 1cm usually single.

does not enlarge further once certain size is reached, does not become darker

Question 2

common sites of oral melanotic macule

Answer 2

h. Sites
Lower lip, gingiva, buccal mucosa

Question 3

tx of Oral melanotic macule

Answer 3

i. Treatment
Best excised, does not recure following excision

Question 4

how does IO mucosa nevus occur

Answer 4

a. Nevus cells migrates into connective tissues. Clustered melanocytes with the ability to migrate to submucosa
Nevus cells are the projections from the stellate shape of the melanocytes

Question 5

what are the clinical appearance of malignant melanoma

Answer 5

i. Asymmetry
ii. Border irregularity
iii. Color variegation
iv. Diameter more than 6mm
Elevation ( surface

Question 6

what is the sites for malignant melanoma

Answer 6

palate, maxillary gingiva

Question 7

where does amalgam tattoo appear

Answer 7

In the vicinity of AR restored teeth, crowned teeth, endo, healed extraction socket

Question 8

what is the histo of amalgam tattoo

Answer 8

i. Fine brown granules staining collagen fibres
ii. Reticulin fibers around blood vessels nerve; lack of inflammation
May or may not have giant cells present

Question 9

what drugs can cause pigmentation

Answer 9

chx, minocycline, zidovudine, ketoconazole, bulsuphan

Question 10

what is hemangioma

Answer 10

a. Common benign neoplasm of infancy
b. True neoplasm of endothelial cells

Question 11

sites of hemangioma

Answer 11

i. Lips> tongue> cheek> palate

60% h and n region

uncommon intra oral

involutes by 5-9 yo

proliferative phase at 1 yo

Question 12

clinical observation of hemangioma

Answer 12

Dark reddish purplish smooth, flat or raised lesion of soft consistency
h. Single> multiple
i. Blanch on pressure
j. Asymptomatic non progressive
k. Ulcerates, bleeds, may compress vital structures if larger. Asymptomatic

Question 13

treatment of hemangioma

Answer 13

i. Watchful waiting for involution
ii. Intervene if life threatening, disfigurement
iii. Medical using beta blockers, corticosteroids
iv. Surgical
Laser

Question 14

what is pyogenic granuloma

Answer 14

a. Non neoplastic proliferation of endothelial cells and capillaries in response to local injury
For eg plaque accumulation, trauma, pregnancy

Question 15

what are the demographics and sites of pyogenic granuloma

Answer 15

b. Occurs in females more than males, peak in the 2nd decade
c. Site
Gingiva (>80%)

Question 16

clinical observation of pyogenic granuloma

Answer 16

d. Painless sessile or pedunculated exohytic, red nodule with smooth or lobulated surface, surface may be ulcerated
Bleed easily, spontaneously under light pressure

Question 17

histology of pyogenic granuloma

Answer 17

i. Numerous endothelial lined channels engorged with RBC, may be organised in lobular pattern
ii. Surface may be ulcerated with mixed inflammatory infiltrate: neutrophils, plasma cells, lymphosites
Mature lesions are more fibrous

Question 18

treatment of pyogenic granuloma

Answer 18

i. Excision, low rate of recurrence
ii. Curettage of underlying tissue recommended
iii. Excision with 2mm margins at its clinical periphery and to a depth to the periosteum or to the causative agent
Foreign body, calculus or defective restoration should be removed as part of the exicision

Question 19

what is kaposi sarcoma

Answer 19

a. Vascular neoplasm of endothelial origin

associated with hhv8

Question 20

what is the treatment of kaposi sarcoma

Answer 20

i. For localised small lesion: local excision, intralesional injection of chemotherapeutic agents
ii. For larger lesions: radiotherapy
iii. Extensive cutaneous lesions: chemotherapy, AZT, HAART

Question 21

what is the histology of kaposi sarcoma

Answer 21

Presents as intramucosal nodule with prominent vascular channel lined by atypical endothelial/spindle cells and areas of extravasated rbcs with haemosiderin

Question 22

what is lymphagioma

Answer 22

§ Histo:
□ Capillary or mostly cavernous endothelial lined spaces containing lymph
§ Malformed dilated lymphatic channels or cysts of varying sizes
§ Results in accumulation of excess lymphatic fluid in affected area
§ Uncommon, diagnosed at birth or within 2 years old
§ Treatment
Usually don’t do anything, observation

Question 23

what is AVM

Answer 23

• Genetic anomalies of vasculature resulting in fistulous connections between arterial and venous vessels; leading to high flow
• Present at birth, persistent, common
• Present intraorally on tongue, FOM, buccal mucosa, palate, intraosseous
• Clinical findings
  ○ Pulsatile mass, palpable thrill, audible bruit
• Intra-oral signs and symptoms
  Tooth mobility, bluish discolouration of gingiva, diffused poorly demarcated radiolucency, life threatening bleed after exo