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OMOPOR > Red/Pigmented Lesions > Flashcards

Red/Pigmented Lesions Flashcards

1
Q

What is Racial Pigmentation?

A

Diffuse intra-oral melanosis in dark-skinned races

Increased but normal melanin formation

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2
Q

Clinical Findings of Racial Pigmentation

A
  1. Buccal gingiva most common
  2. Bilateral symmetrical
  3. Does not alter surface morphology
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3
Q

Clinical Findings of Smoking-associated Melanosis

A
  1. Diffused melanin pigmentation on anterior facial gingiva
  2. Diffused macular melanosis of buccal mucosa, gingiva, tongue
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4
Q

Histopathologic Findings of Smoking-associated Melanosis

A
  1. Increased melanin pigmentation of basal cell layer of surface epithelium
  2. Basilar melanosis with pigmentary incontinence
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5
Q

Differential Diagnosis of Smoking-associated Melanosis

A
  1. Trauma
  2. Neurofibromatosis
  3. Peutz-Jegher’s syndrome
  4. Drug-related pigmentation
  5. Endocrine disturbances
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6
Q

How long does related pigmentation take to disappear after cessation of smoking?

A

Gradually over 3 years

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7
Q

What is Allergic Stomatitis?

A

Type IV hypersensitivity reaction to allergens in direct contact with oral mucosa

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8
Q

Clinical Features of Allergic Stomatitis

A
  1. HALLMARK: Erythema, edema, desquamation, ulcertation
  2. Gingiva, tongue, lining or oral mucosa
  3. Benign mixed white and red lesion
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9
Q

Histhopathologic Findings of Allergic Stomatitis

A
  1. Hyperkeratosis, no epithelial dysplasia
  2. Lichenoid aspect
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10
Q

Differential Diagnosis of Allergic Stomatitis

A
  1. Oral lichenoid contact reaction
  2. Leukoplakia
  3. Focal trauma
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11
Q

Management of Allergic Stomatitis

A
  1. Removal of agent

2 In more severe cases, antihistamine therapy combined with topical anaesthetics

  1. Chronic contact allergy usually respond well to removal of source and topical corticosteroid gel or oral suspension
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12
Q

Define Erythroplakia

A

A red plaque that cannot be clinically or pathologically diagnosed as any other condition.

Greater malignant potential than leukoplakia

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13
Q

Clinical Features of Erythroplakia

A
  1. FOM, tongue, soft palate
  2. Multiple lesions
  3. Well demarcated erythematous patch with soft velvety texture
  4. Asymptomatic
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14
Q

Histopathologic Findings of Erythroplakia

A
  1. Lack of keratin
  2. Severe epithelial dysplasia, carcinoma in situ
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15
Q

Investigations of Erythroplakia

A

Incisional Biopsy

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16
Q

Differential Diagnosis of Erythroplakia

A
  1. Mucositis
  2. Candidiasis
  3. Vascular lesions
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17
Q

Management of Erythroplakia

A

Moderate to severe usually complete surgical excision

Long-term follow up due to recurrence

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18
Q

What is an Oral Melanotic Macule?

A

Flat, brown mucosal discolouration produced by a focal increase in melanin deposition

Melanocytes normal numbers and morphology

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19
Q

Clinical Features of Oral Melanotic Macule

A
  1. Lower lip vermillion (Most common), buccal mucosa, gingiva, palate
  2. Uniformly dark brown, round macule with diameter 7mm or less
  3. Asymptomatic and does not enlarge further/become darker
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20
Q

Histopathologic Findings of Oral Melanotic Macule

A
  1. Increase in melanin in basal and parabasal layers of normal stratified squamous epithelium
  2. Melanin incontinence (Melanin in the sub-epithelial CT)
21
Q

Differential Diagnosis

A

Malignant melanoma

22
Q

Investigations for Oral Melanotic Macule

A

Biopsy those on palate and maxillary alveolar mucosa for histopathological exam to rule out oral melanoma

23
Q

Management of Oral Melanotic Macule

A

For aesthetic areas : Excisional biopsy, electrocautery, laser ablation, cryosurgery

24
Q

What is an acquired melanocytic nevus (mole)?

A

Benign, localised proliferation of nevus cells derived from neural crest → Migrate to epidermis shortly after birth

25
Q

What is a Nevus?

A

Derived from melanocytes, cluster and migrate down into CT

26
Q

Clinical Features of Melanocytic Nevus

A
  1. Painless, raised or flat <1cm
  2. Palate, mucobuccal fold, gingiva
  3. Solitary lesion
27
Q

Classification of Melanocytic Nevustion

A

Junctional nevus: Cluster at epithelial basement membrane junction to form localised pigmentation

Compound nevus: Some clusters migrate into lamina propria while some left at junction

Intramucosal nevus: Eventually all migrate into lamina propria. Brown-black colour

Blue nevus: Remain deep in lamina propria

28
Q

Histopathological Findings od Melanocytic Nevus

A

Superficial nevus cells

  • Organised into small aggregates, appearing round
  • Abundant cytoplasm
  • Intracellular melanin

Deeper nevus cells

  • Less cytoplasm
  • Seldom pigmented
29
Q

Differential Diagnosis of Melanocytic Nevus

A
  1. Melanoma
  2. Other pigmented lesions
30
Q

Management of Melanocytic Nevus

A

Conservative surgical excision for aesthetics

31
Q

What is Post-inflammatory Induced Pigmentation?

A

Inflammation interferes with both melanin synthesis and its transfer to keratinocytes

Damaged epithelial layer decreases shielding of UV light → Induce melanocytes to produce more melanin for basal cell protection

Accumulation of subepithelial melanin

32
Q

Post-inflammatory Induced Pigmentation occurs in which condition?

A

Reticular lichen planus due to constant damage and healing

33
Q

Aetiology of a Melanoma

A

UV radiation exposure from sunlight

34
Q

Risk Factors of Melanoma

A
  1. Fair complexion
  2. History of sunburns in childhood
35
Q

What is Melanoma?

A

Malignancy of melanocytic origin

Aggressive lesion that metastasizes early → Poor prognosis

36
Q

Demographics of Oral Melanoma

A

Rare, middle-aged to elderly

37
Q

Clinical Presentation of Melanoma

A
  1. Brown macule with irregular borders
  2. Nodular, may be flat
  3. Most common on hard palate and maxillary gingiva
38
Q

Histopathology of Melanoma

A
  1. Atypical melanocytes in epithelial and CT junction
  2. Enlarged varying degrees of pleomorphism and hyperchromatism
  3. Radial spread → More superficial
    Vertical spread → Deeper infiltration
39
Q

Investigation of Melanoma

A

Early diagnosis by biopsy → Surgical excision before metastasis

Diagnosis is helped greatly by immunohistochemistry (S-100, MelanA, SOX10)

40
Q

Management of Melanoma

A

Radical excision with or without neck dissection, radiotherapy, immunotherapy

41
Q

Prognosis of Melanoma

A

Poor prognosis due to high level of reccurence, rapid growth and metastasis

42
Q

What is an Amalgam Tattoo?

A

Implantation of dental amalgam within oral mucosa, resulting in pigmentation

42
Q

Clinical appearance of Amalgam Tattoo

A
  1. Black, blue, grey macules
  2. Well-defined, irregular or diffuse
  3. Lateral spread may occur for several months
  4. Gingiva, alveolar mucosa and buccal mucosa
43
Q

Radiographic Findings of Amalgam Tattoo

A

Fragments area densely radiopaque

44
Q

Investigation of Amalgam Tattoo

A

If no metallic fragments found on DPT, biopsy should be obtained to rule out melanocytic neoplasia

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OMOPOR (7 decks)

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