White and Red Lesions

Question 1

A white patch or plaque that cannot be characterized clinically or pathologically as any other disease; cannot be wiped off; not necessarily a pre-malignant lesion

Answer 1

Leukoplakia

Question 2

Mainly in 50-70 year olds; more common in men; 80%-benign changes w/o evidence of dysplasia; 12%-showed mild-moderate dysplasia; 4%-showed severe dysplasia or in situ SCCa; 3% showed invasive SCCa

Answer 2

Leukoplakia

Question 3

Possibly one of the most common oral lesions; normal hyperplastic tissue (callus); not pre-malignant; reversible after elimination of traumatic agent

Answer 3

Hyperkeratosis

Question 4

Young adult male w/ white corrugated area in lower anterior vestibule or posterior buccal mucosa; changes are in the “pouch” area; thickened, white, corrugated mucosa; “elephant skin”; mobile, asymptomatic; usually improves/resolves if discontinued

Answer 4

Snuff dipper’s keratosis

Question 5

Characteristic “church spire” or “chevron” formation

Answer 5

Snuff dipper’s keratosis

Question 6

Autosomal dominant transmitted genodermatosis; usually congenital but may develop in early teen years; thick, corrugated, diffuse plaques distributed bilaterally (symmetrical) on buccal mucosa; usually spares attached gingiva

Answer 6

White sponge nevus

Question 7

Progressive and relentless form of leukoplakia; Elderly women: mean age 70 years; Buccal mucosa>alveolar mucosa>tongue; Evolves over decades; recurs despite surgical excision; Tobacco usage<60%; resembles verrucous carcinoma histologically

Answer 7

Proliferative verrucous leukoplakia

Question 8

Defined as red patch that cannot be clinically or pathologically diagnosed as any other condition; much less common than leukoplakia but much more likely to be malignant or premalignant; usually asymptomatic, well-demarcated erythematous macule or plaque

Answer 8

erythroplakia

Question 9

About 90% show epithelial dysplasia or carcinoma; atrophic epithelium with little keratin; biopsy necessary if no obvious cause of irritation present

Answer 9

erythroplakia

Question 10

Recently recognized gingival condition that was originally described affecting only children and adolescence; vivid red patches involving the marginal gingiva of anterior teeth; localized, slightly raised, and painless

Answer 10

Localized spongiotic gingival hyperplasia

Question 11

Defined as a lesion with histologic alterations suggesting a greater likelihood of malignant transformation; transformation rates vary 16-33%; the higher the degree of dysplasia the increased probability of malignant transformation

Answer 11

Epithelial dysplasia

Question 12

increased nuclear to cytoplasmic ratio; increased mitotic activity; cellular pleomorphism; nuclear hyperchromaticity; enlarged nucleoli; abnormal maturation; basilar hyperplasia; loss of basilar layer; loss of cellular cohesiveness; individual cell keratinization; bulbous rete ridges

Answer 12

epithelial dysplasia

Question 13

Risk factors of _ and _ cancers?
Use of any king of tobacco product; heavy use of alcohol; nutritional deficiencies; marijuana use; male older than 45; sun exposure; rare congenital/inherited syndromes; viruses (HPV)

Answer 13

oral and pharyngeal cancers

Question 14

An invasive neoplasm with squamous epithelial origin and differentiation; cords, sheets, islands, nests, or individual squamous cells invade through the basement membrane into the underlying lamina propria; Neoplasm may then invade deeper structures such as adipose tissue, nerves, skeletal muscle, or bone; angioinvasion into blood vessels or lymphatics allows the tumor to travel to distant sites

Answer 14

Squamous cell carcinoma

Question 15

Most common oral cavity cancer; clinically, the lesion is often present for 4-8 mos before the patient seeks medical attention

Answer 15

Squamous cell carcinoma

Question 16

Which location of OSCC?: Accounts for more than 50% of intraoral cancers; 65% of the time: posterior lateral border; usually appears as a painless indurated mass or ulcer

Answer 16

tongue

Question 17

Which location of OSCC?: 35% of all intraoral SCC; males more than females; usually begins as a leukoplakia or erythroplakia; most common in the midline

Answer 17

floor of mouth

Question 18

Which location of OSCC?: Typically found in light-skinned individuals with chronic sun exposure; most patients have outdoor occupations; usually presents as a longstanding, slow growing, crusted, oozing, indurated ulceration

Answer 18

Lower lip

Question 19

Which location of OSCC?: the least associated with tobacco smoking and has the greatest predilection for females; arises from keratinized mucosa in the posterior mandible; may mimic benign reactive conditions such as pyogenic granuloma or periodontal disease; underlying bone destruction is common leading to tooth mobility

Answer 19

Gingiva

Question 20

A variant of SCC composed of cytologically malignant epithelial cells caused in part by HPV 16/18; more common within the larynx and upper aero-digestive tract

Answer 20

p16+ Oropharyngeal SCC

Question 21

A rare variant of SCC characterized by a papillary clinical appearance, bland cytomorphology with “pushing” borders and a relatively good prognosis; 1-9% of all oral SCCs; Males>Females; average age: 65 years; associated with tobacco

Answer 21

Verrucous carcinoma

Question 22

Usually affects the buccal mucosa, gingiva, although any mucosal area may be affected; diffuse, well-demarcated painless thick plaque with papillary surface projections; may become fixed to the periosteum (and invade the bone); May present with clinically enlarged cervical lymph nodes

Answer 22

Verrucous carcinoma