Red, White and Pigmented Lesions Flashcards
Haemangioma:
1. Describe the appearance
2. How do they respond to pressure?
3. What is the treatment for this?
4. If treatment is done, where should it be carried out and why?
- Red or blue painless lesion usually on lips or tongue
- When pressure is applied, they will blanch
- Treatment - monitor and potential surgical removal or laser removal at patient’s request
- Surgical removal needs to be done in a hospital as there is risk of severe haemorrhage
Kaposi’s Sarcoma:
1. Which 2 infections is this associated with?
2. How does it present?
3. How is it treated?
4. What type of cancer is this?
- HIV and Herpes 8
- Red, purple/brown tumours on palate or gingiva
- Treated - in HIV patients the HAART drugs can help to slow the progression of Kaposi’s sarcoma
- Sarcoma of blood vessels
Erythroplakia:
1. How does it present clinically?
2. What does this pose an increased risk of?
3. Why is this unique of all oral lesions?
4. How is this treated?
- Bright red velvety patches, mainly of soft palate, FOM or buccal mucosa
- Increased risk of malignant transformation
- This is the most serious of all oral premalignant lesions
- Treatment - Removal of risk factors e.g. smoking or alcohol and BIOPSY needed to treat further
Fungal - Acute and chronic erythematous candidosis:
Acute:
1. List 2 associations
Chronic:
1. What is this caused by and give the term
Acute:
1. Associated with antibiotic use and HIV
Chronic:
1. Caused by wearing dentures too often - Denture stomatitis
Black hairy tongue:
List 4 associations:
What mouthwash can also cause discolouration of the tongue - give chemical name also.
-How long is the recommended use for this?
- Soft diet
- Smoking
- Poor OH
- Dry mouth
Corsodyl mouthwash - chlorhexidine
-Use for no longer than 2 weeks
- What substance in the body cause most endogenous lesions?
- List 2 reasons why this occurs:
- Melanin
- a) Over production of melanin by melanocytes (e.g. inflammation)
b) Increased release of melanin from cell death of keratinocytes (e.g. smoking)
Idiopathic melanotic macules:
1. How do they present?
2. Are they serious?
3. How are they treated?
- Flat, singular brown spots
- Common benign lesions
- Recommended to remove as could potentially be melanoma
Melanotic Naevus:
1. How does this present clinically?
2. Are there any symptoms?
3. How is this treated
- Blue-black benign lesions on palate or on gingiva
- Asymptomatic
- Removed by excision to exclude possibility of melanoma
Racial pigmentation - what is this?
Brown pigmentation mainly affecting the gingiva - seen mainly in black and ethnic minorities
Smokers Melanosis:
1. How does this present?
2. What causes this?
- Presents as a brown/black pigmentation on the gingiva, buccal mucosa, palate and larynx
- The toxic chemicals in smoke bind to melanin in epithelial cells and travel to tissue surface - causes the pigmentation
Puetz-Jegher Syndrome:
1. How does this present?
2. What causes this?
3. How is this treated?
4. Does this need to be referred and why?
- GI polyps and melanotic spots on lips and oral mucosa
- Caused by genetic factors - very rare
- Excision to treat
- Yes, needs to be referred for cancer screening due to high risk of colon and breast cancer
Addison’s (adreno-cortical insufficiency):
1. What is it?
2. How does it present clinically?
3. How is this treated?
4. What is the test for Addison’s disease?
- Destruction of adrenal glands - adrenocortical
- Brown pigmentation of gingiva and oral cavity
- Treatment with replacement therapy of corticosteroids
- Synacthen test - measurement of serum electrolytes
Albrights Syndrome:
1. What is this?
2. How does this present clinically?
- A genetic bone disorder and skin pigmentation
- ‘Cafe au lait’ pigmentation on the skin
Sarcoidosis:
1. What is this?
2. How does this present clinically?
- Exaggerated immune response - body attacks its own tissues and organs
- Hyperpigmented lip lesions, multiple granulomas
What is drug-induced endogenous oral pigmentation caused by?
Chloroquine
Leukaemia: How does this present in the oral cavity?
Haemorrhagic areas/patches commonly along the gingiva
Malignant Melanoma:
1. How does this present?
2. List 4 signs of malignancy
3. How is this treated?
- Heavily pigmented macule affecting the palate or maxillary gingiva
- -Rapid increase in size
-Change in colour
-Ulceration
-Pain - Treatment - radical excision
Frictional keratosis:
1. List 3 things this is caused by?
2. How does this present clinically?
3. How is this treated?
- Sharp teeth, cheek biting, dentures
- Pale white patches which become more dense and whiter
- Treat - remove stimuli and biopsy white patches
Frictional keratosis:
1. List 3 things this is caused by?
2. How does this present clinically?
3. How is this treated?
- Sharp teeth, cheek biting, dentures
- Pale white patches which become more dense and whiter
- Treat - remove stimuli and biopsy white patches
Nicotinic stomatitis:
1. What causes this?
2. How does this present clinically?
3. How is this managed?
- Long-term cigar/pipe smoking
- Hyperkeratosis - mostly effects the palate
- Management - encourage patient to stop smoking
Actinic Cheilitis: (Sailors/farmer’s lip)
1. What causes this?
2. How does it present? - give 3 features
3. Is this potentially malignant?
- Caused by long-term exposure to sunlight
- White lesions, red/erosive/ulcerative lesions, scaley hardened skin around the lips
- Yes! potential for malignancy
Lichen planus:
1. How does this present?
2. What causes this?
3. Does it require treatment?
- White interlacing lines usually bilateral on buccal mucosa, gingiva and tongue
- Cause is unknown
- Usually left untreated
Lichenoid Reactions:
1. What causes this?
2. How does it present?
3. How is it treated?
- Caused by a reaction to a drug or material
- Similar presentation to lichen planus - white interlacing lines
- Treatment - remove the cause
Leukoplakia:
1. What is this?
2. What causes this?
- A white patch on mucous membrane that does not rub off
- Cannot be associated with anything other than the use of TOBACCO
Idiopathic leukoplakia:
1. What causes this?
2. How does it present clinically?
3. Where in the oral cavity would you expect to see this?
- Cause is unknown
- Tough and raised plaques and can have red, nodular lesions - BE SUSPICIOUS - HIGH RISK MALIGNANCY
- Seen on FOM, tongue, posterior regions in oral cavity
Candidal Leukoplakia:
1. How does this present?
2. List 3 steps taken to treat
- Appears bilaterally in commissure on the cheek and can have speckled background
- Treat with antifungals, smoking cessation, biopsy
Syphilitic Leukoplakia:
1. How does this present?
2. What causes this?
3. How is this diagnosed?
- White lesions on dorsum of tongue - usually spares the margins
- Normally complication of tertiary syphilis
- Diagnosed by serology - biopsy is essential - HIGH MALIGNANCY POTENTIAL
Hairy Leukoplakia:
1. What causes this?
2. How does it present clinically?
3. How is this diagnosed?
- Link to Epstein-Barr virus and HIV patients
- Soft, usually painless white plaques with corrugated surface - typically on lateral boarder of the tongue
- Biopsy essential for diagnosis - indicates rapid progression of HIV into AIDS
Speckled Leukoplakia:
1. What is this seen as a combination of or transition between?
2. How does it present?
3. Which has a higher rate of malignant change, speckled or non-speckled?
- Combination or transition between leukoplakia and erythroplakia
- Presents as white and red speckled patch
- Speckled leukoplakia has higher rate of malignant change
White Sponge Naevus:
1. How does this present?
2. Other than oral cavity, where can this present?
3. How is it diagnosed and how serious is it?
- White shaggy or wrinkled surface on mucosa
- Can affect anus or vagina
- Needs biopsy to confirm diagnosis
-Reassure patient condition is BENIGN
Oral submucous fibrosis:
1. How does this present?
2. What can cause this?
3. How is this treated?
- Tight vertical lines in buccal mucosa which can restrict oral opening and mucosa is pale
- Can be caused by genetic factors and betel nut chewing
- Treated - remove nuts, jaw exercises, corticosteroids
Keratinising carcinomas can appear as and in what?
Keratinising carcinomas can appear as or in ORAL WHITE LESION
