Tutorial 1 Flashcards
what clinical features of a lesion would you assess
[white lesion, lateral border of tongue]
hardness
tethering
induration
exophytic
is it wipeable
texture
what social history questions would you ask a pt
smoking
drinking
stressors
who they live with
what social history factors would put pt at higher risk of malignancy
smoking
drinking
previous cancer
SE group
chewing tobacco
paan use
what further questions would you ask re-smoking
if they wanted further support/advice for stopping - where would you send them
how often/many, what type, when did you start, have you though about quitting
pharmacy, local smoking cessation groups, GP
white lesion presenting on lateral border of the tongue
poorly defined borders, smooth, flat, homogenous, 1cm
give differential diagnoses
traumatic keratosis
homogenous leukoplakia
how would you manage pt with white lesion at initial appt
assess risk factors
smooth any sharps
clinical photo
encourage smoking cessation
review
describe geographic tongue
scalloping
loss of filiform papillae
areas of hypertrophy and hyperkeratinisation
describe pathophysiology of geographic tongue
inflammatory
genetic
associated with psoriasis
nutritional deficiencies
management of geographic tongue
reassure, normal anatomy
avoid trigger foods like tomatoes, SLS free TP
use of difflam if stings
what questions would you ask 65y/o female presenting with white area on tongue which has been present for a few weeks but doesn’t know if getting bigger or smaller
when did you notice
any pain, bleeding
does it rub away
any changes
any numbness/altered sensation
any difficulty/changes to swallowing
what systemic medical problems or medications could cause a white patch in the mouth
inhalers
candida infections
smoking
aspirin burns
epstein barr virus
hpv
white patch lesion from tongue extending to FOM
there is no obvious traumatic cause
what is differential diagnosis
homogenous leukoplakia
biopsy of white patch lesion from tongue extending to FOM shows;
no evidence of dysplasia or malignancy, no inflammation, negative for fungi
BUT
shows areas of hyperorthokeratosis
what is the diagnosis
excessive thickening of stratum corneum
what intrinsic, chemical and extrinsic factors could cause pigmentation of oral cavity
amalgam
CHX
tobacco
heavy metals
melanin
foreign bodies
what systemic health conditions are associated with oral pigmentation
Addison’s disease
Peutz-Jehgers syndrome
inflammation
pigmentation
what malignancies present as pigmented lesions
how would you differentiate between a non-malignant process
melanoma
kaposi’s sarcoma
asymmetry, border irregularity, colour irregularity, diameter >6mm, evolving
pt presenting with pigmented lesion is referred to 2nd care
they are fatigued, muscle weakness and unintentional weight loss
->what would this raise concerns of
-> how would you investigate this
Addisons disease
ACTH levels via blood
serum cortisol level
describe the pathogenesis of Addisons disease
describe how it causes pigmentation
adrenal glands cannot produce enough steroid, adrenal insufficiency leads to increased adrenocorticotrophic hormone (ACTH) via pituitary,
this causes pigmentation by stimulating melanocytes
if pt presents with oral pigmentation and GI upset
what systemic disease would this raise concerns of
Peutz Jehgers syndrome
where would you take a biopsy from in
“ white, plaque like lesion, irregular shaped, homogenous”
multiple areas where the white patch meets normal tissue
what is dysplasia
abnormal cellular changes which are at higher risk of malignancy but not termed pre-cancerous
what histopathological features may be seen in dysplasia
architectural =
- irregular epithelial stratification
- loss of polarity of basal cells
- drop-shaped rate ridges
- increased mitotic figures
cytological =
- abnormal variation of cell size/shape
- abnormal variation of nuclei size/shape
- hyperchromasia
pathology report indicated high grade dysplasia
->how would you manage this is oral med
-> what further intervention will be offered
highly suspicious for malignancy
needs to go to maxfax
excision
MDT decision if chemo/radio
if carcinoma = 1cm taken from around the lesion
