Week 2- OPMD's Flashcards
What are the 2 types of OPMD’s?
- Discrete mucosal lesions
- Widespread conditions
What is the definition of a discrete mucosal lesion OPMD?
Morphologically altered tissue in which oral cancer is more likely to occur than in its apparently normal counterpart
What is leukoplakia?
White patch which cannot be wiped off the mucosa or ascribed to any other clinical or histo-pathological condition; by definition it has a potentially malignant predisposition
Why does leukoplakia appear white?
Hyperkeratinisation
Keratin absorbs saliva
What is the estimated prevalence of leukplakia?
1.7-2.7%
What are characteristics of proliferative verrucous leukoplakia?
- Slow growing
- Multi-focal leukoplakia
- Fissured, exophytic, warty-looking
- Older females
- Not associated with tobacco and alcohol
What can proliferative verrucous leukoplakia be dismissed as?
Frictional hyperkeratosis
What is the transformation rate of proliferative verrucous leukoplakia?
70%
What is erythroplakia?
Well-defined, velvety-red, depressed patch most common in FOM. 40% are already invasive SSC.
What is erythroleukoplakia?
White flecks or nodules on atrophic erythematous base
Where can erythroleukoplakia be found?
FOM, buccal mucosa, labial commissures
What is oral submucous fibrosis and why is it at increased risk of malignant transformation?
Rx to areca nut chewing. There is thickened collagen laid down in sub mucosa which gives rise to trismus. Oral epithelium becomes atrophic which increases risk of malignant transformation.
What 3 oral diseases are associated with iron deficiency?
Plummer-Vinson Syndrome
Sideropaenic Dysphagia
Peterson-Kelly-Brown Syndrome
How should chronic hyperplastic candidosis be treated? Why?
Treat with systemic antifungals.
Topical anti-fungals don’t work as candida hyphae extend 2/3 of depth through epithelium and therefore won’t penetrate that far. Need systemic antifungals to reach it (fluconazole 50mg once a day for 7 days).
What are characteristics of discoid lupous erythematosus?
Butterfly rash across cheeks. Subtle star shaped erosions and redness.
What is this disease?
Actinic Cheilitis
What are characteristics of lichen planus?
- Mucocutaneous disorder
- Rashes on legs and arms
- Lace-like white patterns and hyperkeratosis
- Sometimes erosions and atrophy on mucosa
What lichenoid lesions are high risk vs not high risk for malignant transformation?
- Isolated lichenoid lesions on tongue- high risk for malignant transformation.
- Classic bilateral mucocutaneous lichen planus- not high risk for malignant transformation
What is this disease?
Tertiary Syphilis
What is the malignant transformation rate?
12%
What are high risks of malignant change?
- Floor of Mouth, Ventro-Lateral Tongue, Retromolar Regions
- Erythroplakia and Erythroleukoplakia
- Nodular (non-homogeneous) Leukoplakia
- Larger Lesions
- Non-Smokers, Females, Older Patients
- ‘High Grade’ Dysplasia
What are management goals for OPMD’s?
- Accurate Diagnosis
- Prediction of Clinical Behaviour
- Early Recognition of Malignancy
- Removal of Dysplastic Mucosa
- Prevention of Recurrence
- Prevent Malignant Transformation
- Minimal Patient Morbidity
What is the best treatment for OPMDs?
Surgical intervention (laser, cryotherapy, scalpal, photodynamic therapy)
What are benefits of CO2 Laser Surgery?
- Rapid precise dissection
- Reduced scarring
- Good pt acceptance
- Low morbidity
- Post-op analgesia
- Haemostasis
- Facilitates histopathological diagnosis
