Red & Pigmented Soft Tissue Lesions

Question 1

A 10 y/o boy presents with multiple, focal brown macules averaging 1-4mm in diameter around the vermillion and labial mucosa. It can also be seen around his fingers. Which of the following is the most likely diagnosis?

McCune Albright syndrome
Peutz-Jeghers syndrome
Racial pigmentation
Smoking associated melanosis

Answer 1

Peutz-Jeghers syndrome

Question 2

Which of the following is not a clinical feature of melanoma?

Asymmetry of the lesion
Diameter of lesion is > 6mm
Lesions change with respect to size, shape, color, surface of symptoms over time
Regular borders

Answer 2

Regular borders

Question 3

A patient presents with multiple focal melanotic brown macules, concentrated periorally. Some macules were also found on cheek mucosa, fingers and hands. Patient says that macules have been there for as long as he can remember. What condition is this likely to be and how will you manage it?

Addison’s disease, correct endocrinopathy
Peutz Jegher Syndrome, warn of increased cancer risk and encourage screening
Smokers melanosis, counsel smoking cessation
Racial pigmentation, no management needed

Answer 3

Peutz Jegher Syndrome, warn of increased cancer risk and encourage screening

Question 4

A 40 y/o female patient came into the dental clinic to get a check-up. You notice a flat, well-circumscribed and solitary blue-black lesion on her maxillary buccal gingiva. A biopsy was then done and the histopathology findings showed an increase in melanin production but normal numbers of melanocytes. What is the most likely diagnosis?

Oral melanotic macule
Oral melanoma
Oral melanocytic naevi
Physiologic pigmentation

Answer 4

Oral melanotic macule

Question 5

Which of these are true about between hemangiomas and varixes

Hemangiomas most commonly found on the lips but varix more commonly found on the palate
Hemangiomas do not require treatment but varix has to be excised
Both hemangiomas and varix occur at birth

Answer 5

Both hemangiomas and varix occur at birth

Question 6

Which is true about infantile hemangioma?
It is a type of capillary malformation
It persists throughout life
It is present at birth
It is a true neoplasm of endothelial cells

Answer 6

It is a true neoplasm of endothelial cells

Question 7

A medically healthy 18 year old female comes into the clinic with several diffused brown macules on attached gingiva . She has no history of smoking. What is the most likely condition?
Drug-induced pigmentation
Smoking-Associated Melanosis
Oral Melanotic Macule
Racial pigmentation

Answer 7

Racial pigmentation

Question 8

A 25-year-old patient presents with an exophytic red nodule as shown in the picture. Which of the following would you expect the lesion to be?

https://pasteboard.co/sv7Ro9v9SmnL.png

Pus-filled
Painful
Bleeds easily spontaneously or under light pressure
More common in males than females

Answer 8

Bleeds easily spontaneously or under light pressure

Question 9

Which of the following describes smoker’s melanosis?
It is most often found on the labial gingiva.
It is a non-melanin derived condition.
It exists as a localised pigmentation.
Giant cells can be seen under histology.

Answer 9

It is most often found on the labial gingiva.

Question 10

Which of the following conditions is characterised by red pigmented lesions that typically appear as small flat spots on the skin?
Melanoma
Hemangioma
Pyogenic granuloma
Lymphangioma

Answer 10

Hemangioma

Question 11

Which of the following is NOT a differential dx for kaposi sarcoma?
pyogenic granuloma
Melanoma
Angiosarcoma
Allergic stomatitis

Answer 11

Allergic stomatitis

Question 12

A patient presents with multiple irregular pigmented lesions on his palate and maxillary gingiva. The dentist noted that some of the lesions were elevated and measured more than 6mm in diameter. What is the most likely differential diagnosis?
Amalgam Tattoo
Melanoma
Melanotic Macule
Oral Melanocytic Naevi

Answer 12

Melanoma

Question 13

Which of the following erythemaous lesions is NOT due to infection?
Denture induced stomatitis
Median rhomboid glossitis
Angular chelitis
Geographic tongue

Answer 13

Geographic tongue

Question 14

A 25 year old pregnant female presented to your clinic with a painless, exophytic, red nodule that bleeds under light pressure. It appeared only during the course of her pregnancy. What is the most likely differential diagnosis?

https://pasteboard.co/yyR2gmiYxLKF.png

Arteriovenous Malformation
Kaposi’s sarcoma
Pyogenic granuloma
Varix

Answer 14

Pyogenic granuloma

Question 15

Which is true regarding smoker’s melanosis?
A. Increased melanin pigmentation on the squamous cell layer of surface epithelium
B. Treatment requires conservative surgical excision (5% recurrence rate)
C. Exposure to polycyclic ketones such as nicotine and benzpyrene has been shown to stimulate melanin production
D. Histopathologic findings include basilar melanosis with pigmentary incontinence

Answer 15

D. Histopathologic findings include basilar melanosis with pigmentary incontinence

Question 16

Which of the following lesion is associated with its most common site?
Melanotic macule - upper lip vermillion
Melanolytic nevus - buccal mucosa
Pyogenic granuloma - gingiva
Hemangioma - tongue

Answer 16

Pyogenic granuloma - gingiva

Question 17

Which of the following is true of racial pigmentation?
It is due to an increase in melanin formation due to an increase in number of melanocytes.
It is only localised in the anterior buccal gingivae in dark-skinned races.
It is due to an increase in melanin formation without an increase in number of melanocytes.
Histological studies show that there is basilar melanosis with pigmentary incontinence.

Answer 17

It is due to an increase in melanin formation without an increase in number of melanocytes.

Question 18

What is NOT true about oral melanotic macule?

They are usually small, solitary, well-circumscribed, uniformly pigmented macular lesions
They are painless lesions, with flat brownish-black patches
Once it reach a certain size, it does not become darker
The melanocytes becomes dysplastic due to an inherited defect of the melanocytes

Answer 18

The melanocytes becomes dysplastic due to an inherited defect of the melanocytes

Question 19

A 45 year old patient comes into your clinic complaining of a single, uniformly brown macule on his maxillary buccal gingiva. He states that he is embarrassed of his appearance due to the macule. The lesion is round, flat and well-circumscribed and the patient is not experiencing any signs or symptoms. What would your diagnosis and management of the lesion be?

Racial pigmentation, no treatment
Melanoma, radical excision
Melanotic nevus, no treatment
Oral melanotic macule, excision

Answer 19

Oral melanotic macule, excision

Question 20

Which pigmented lesion of the Oral Mucosa has localized pigmentation?
Black Hairy Tongue
Melanotic Macule
Racial Pigmentation
Smoker’s melanosis

Answer 20

Melanotic Macule

Question 21

A 40 year old man walks into your clinic and complains about the single black lesion on the buccal mucosa. Upon taking medical history, you found out that the patient is a smoker. You decide to take an excisional biopsy. Histology shows that there is a lack of inflammation with giant cells present. Which of the following lesions could it be?

https://pasteboard.co/C2wXtARQT0nO.png

Smoker’s melanosis
Malignant melanoma
Oral Melanocytic Macule
Amalgam Tattoo

Answer 21

Amalgam Tattoo

Question 22

which of the following description of pigmented lesion is true?

Black Hairy tongue: Accmulation of keratin in fungiform papilla on dorsum tongue, caused by dehydration & poor diet
Erythroplakia: present with severe epithelium dysplasia and has lower malignant transformation rate compared to leukoplakia
Melanotic macule: painless brown evenly pigmented small macule, usually on lip vermillion and common in kids.
Pyogenic granuloma: neoplastic proliferation of endothelial cells and capillaries in response to local injury

Answer 22

Melanotic macule: painless brown evenly pigmented small macule, usually on lip vermillion and common in kids.

Question 23

A patient presents with a red to purple patch which later developed into a nodular, ulcerative and multi-focal lesion. Which of the following histological features would aid in confirming the diagnosis of this lesion as Kaposi’s Sarcoma?

Presence of numerous endothelial lines channels that are engorged with RBCs
Presence of dilated blood-filled vascular channel lined with single layer of flattened endothelial cells and a thin wall of fibrous tissue filled with RBCs
There is no need for histology as the condition can be diagnosed clinically.
Presence of cellular proliferation of spindle cells with vascular channels lining them with presence of extravasated RBCs with hemosiderin.

Answer 23

Presence of cellular proliferation of spindle cells with vascular channels lining them with presence of extravasated RBCs with hemosiderin.

Question 24

Which of the following is false about contact stomatitis?

An inflammatory process involving the oral mucosa in contact with irritant or allergen
Local reaction after repeated or direct surface mucosal exposure to physical or chemical irritant
T cell mediated, delayed type IV hypersensitivity reaction to successive exposure to contact allergens
Appear as smooth compressible swellings under normal/bluish skin as macrocystic malformations

Answer 24

Appear as smooth compressible swellings under normal/bluish skin as macrocystic malformations

Question 25

Which of the following is a true of oral melanotic macules?

High recurrence rate following excision
Increased number of melanocytes
Most commonly found on lower lip
Potential for malignant transformation

Answer 25

Most commonly found on lower lip

Question 26

25 year old Mrs Loew, visited you as she is concerned with a single paineless red lump on her gums. Upon clinical examination, the surface of the lesion looks ulcerated and it bled spontaneously under light pressure. Which lesion is it most likely

https://pasteboard.co/yyR2gmiYxLKF.png

pyogenic granuloma
pleomorphic adenoma
Lymphangioma
fibrous hyperplasia

Answer 26

pyogenic granuloma

Question 27

Vascular Malformations and Hemangiomas are non-cancerous endothelial lesions. We can distinguish the two by the following statements except..

Hemangiomas are usually absent at birth while vascular malformations are present from birth
Hemangiomas grow rapidly during infancy while vascular malformations grow proportionally to the childs growth
Hemangiomas are usually self-limiting while vascular malformations never disappear
Hemangiomas blanch on pressure while vascular malformations do not blanch on pressure

Answer 27

Hemangiomas blanch on pressure while Vascular Malformations do not blanch on pressure

Question 28

A 50 year old Indian male patient presents with a single bluish-black macular entity on the buccal gingiva of his #46. You observe a couple of amalgam restorations done on his posterior teeth. He also has a previous smoking history of 10 years but has quit smoking a year ago. Which of the following is the most likely differential diagnosis?

Amalgam tattoo
Malignant melanoma
Racial pigmentation
Smoker’s melanosis

Answer 28

Amalgam tattoo

Question 29

Which of the following is false regarding vascular tumours?

Growth of tumour is proportional to age.
Histologically present as endothelial cell hyperplasia.
Prevalance is higher in females.
Usually absent at birth.

Answer 29

Growth of tumour is proportional to age.

Question 30

Small, solitary, well-circumscribed, uniformly pigmented macular lesions were observed in the oral cavity. They are painless, flat and brownish black. What will be the appropriate management in this situation?

No treatment
Exicional biopsy
Excision
Incisional biopsy

Answer 30

No treatment

Question 31

Which of the following is true regarding a pyogenic granuloma?

More common in males than females
It is a malignant neoplasm
It bleeds spontaneously/ under light pressure
It is caused by epithelial proliferation

Answer 31

It bleeds spontaneously/ under light pressure