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OMOPOR > White Lesions > Flashcards

White Lesions Flashcards

1
Q

What are Fordyce Granules?

A

Sebaceous glands that occur in the oral mucosa

Considered a normal anatomic variation

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2
Q

Demographics of Fordyce Granules

A

Seen more commonly in adults

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3
Q

List Developmental White Lesions

A
  1. Fordyce granules
  2. Leukoedema
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4
Q

Clinical presentation of Fordyce Granules

A
  1. Multiple small yellow papules
  2. Asymptomatic
  3. Buccal mucosa or lateral portion of vermillion border of upper lip
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5
Q

What is Leukoedema?

A

Edematous changes in the oral mucosa

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6
Q

Demographics of Leukoedema

A
  1. More common in black and smokers
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7
Q

Clinical Features of Leukoedema

A
  1. Diffuse, gray-white opalescent appearance of mucosa
  2. Folded surface appear as white streaks
  3. Lesions do not rub off but diminishes or disappears when cheek is stretched
  4. Bilaterally on buccal mucosa
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8
Q

Histopathological Findings of Leukoedema

A
  1. Acanthosis present, parakeratinised epithelium + Broad and elongated rete ridges
  2. Intracellular oedema of spinous layer
  3. Vacuolated cells appear large and have pyknotic nuclei
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9
Q

Differential Diagnosis of Leukoedema

A
  1. Leukoplakia
  2. Candidiasis
  3. Lichen planus
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10
Q

What is Benign Alveolar Ridge Keratosis?

A

Frictional keratosis caused by masticatory function or denture trauma

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11
Q

Clinical Findings of BARK

A

Poorly demarcated white plaque of keratinised mucosa of alveolar ridge or retromolar pad

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12
Q

List Reactive White Lesions

A
  1. Benign Alveolar Ridge Keratosis
  2. Frictional Hyperkeratosis (Linea Alba, Morsicato Buccarum

3, Nicotinic Stomatitis

  1. Coated tongue
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13
Q

What is Linea Alba?

A

Common alteration of buccal mucosa associated with pressure, frictional irritation or sucking trauma from the facial surface of teeth

Benign, reactive hyperkeratosis

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14
Q

Clinical Features of Linea Alba

A
  1. Bilateral white line, may be scalloped
  2. Buccal mucosa at level of occlusal plane of adjacent teeth
  3. Only at dentulous areas, especially posterior teeth
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15
Q

What is Morsicato Buccarum?

A

Chronic chewing of oral mucosa

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16
Q

Clinical Features of Morsicato Buccarum

A
  1. Bilaterally on anterior buccal mucosa
  2. Thickened, shredded white areas combined with intervening zone of erythema, erosion or focal traumatic ulceration
  3. White mucosa demonstrates irregular surface
  4. Periphery gradually blends with adjacent mucosa
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17
Q

Histopathological Findings of Frictional Hyperkeratosis?

A
  1. Extensive hyperparakeratosis
  2. Acanthosis
  3. Keratinocyte edema
  4. Lack of dysplasia
  5. No inflammatory infiltrate
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18
Q

What is Nicotinic Stomatitis?

A

Hyperkeratotic lesion associated with tobacco smoking

Develops in response to heat

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19
Q

Clinical Appearance of Nicotinic Stomatitis

A
  1. Palatal mucosa diffusely grey or white
  2. Numerous slightly elevated papules, usually with punctuate red centres
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20
Q

Management of Nicotinic Stomatitis

A

Completely reversible within 1-2 weeks of smoking cessation

Not pre-malignant

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21
Q

Histopathological Findings of Nicotinic Stomatitis

A
  1. Hyperkeratosis and acanthosis
  2. Mild, patchy, chronic inflammation of subepithelial connective tissue and mucous glands
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22
Q

What is Hairy Tongue?

A

Marked accumulation of keratin on the filiform papillae of dorsal tongue

Represents an increase in keratin production or decrease in normal keratin desquamation

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23
Q

Clinical Features of Hairy Tongue

A
  1. Midline, anterior to circumvallate papillae
  2. Elongated papillae is brown, yellow or black
  3. Dorsal has thick or matted appearance
  4. Asymptomatic, sometimes gagging sensation or bad taste in mouth
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24
Q

Clinical Features of Coated Tongue

A
  1. Numerous bacteria and desquamated epithelial cells accumulate on dorsal tongue surface, WITHOUT hairlike filiform projections
  2. Source of malodour
  3. May be scraped off lightly but with difficulty
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25
Q

Histological Features of Hairy Tongue

A
  1. Marked elongation and hyperparakeratosis of filliform papillae
  2. Numerous bacteria can be seen growing on epithelial surface
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26
Q

Differential Diagnosis of Hairy Tongue

A

Candidiasis

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27
Q

Clinical Features of Smokeless Tobacco Lesions

A

Characteristic white or grey plaque involving mucosa in direct contact with snuff or chewing tobacco

or

Tobacco pouch with no induration, ulceration and pain

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28
Q

Definition of Leukoplakia

A

White plaque that cannot be characterised clinically as any other disease, presence of dysplasia, considered pre-malignant

29
Q

Prevalence of Leukoplakia

A

Most common oral pre-malignant lesion (85%)

30
Q

Demographics of Leukoplakia

A
  1. Males
  2. Older than 40 years old
31
Q

Clinical Appearance of Early, mild or thin leukoplakia

A
  1. Flat to slightly elevated, white plaque which may be translucent and wrinkled
  2. Sharply demarcated borders, may blend in with normal mucosa
  3. Seldom show dysplasia on biopsy
32
Q

Clinical Appearance of Homogeneous or thick leukoplakia

A
  1. Thickened, leathery, distinctively white plaque with deepened fissures
  2. Most remain indefinitely (1/3 disappears)
33
Q

Clinical Appearance of Granular or nodular leukoplakia

A

Some lesions develop increased surface irregularities

34
Q

Clinical Appearance of Verrucous or verruciform leukoplakia

A

Lesions with sharp or blunt, wart-like projections

35
Q

What is Proliferative Verrucous Leukoplakia (PVL)?

A
  1. High-risk of leukoplakia that exhibits persistent growth and transform into SCC
  2. Multiple, slowly spreading keratotic plaques with rough surface projections
36
Q

What is Erythroplakia?

A
  1. Intermixed red and white lesion
  2. Exhibits advanced dysplasia
  3. Epithelial cells are atrophic and can no longer produce keratin
37
Q

Investigation for Leukoplakia

A

Incisional Biopsy

38
Q

Differential Diagnosis of Leukoplakia

A
  1. Chronic hyperplastic candidiasis
  2. Oral lichen planus (No dysplasia)
  3. Leukoedema
39
Q

Management of Leukoplakia

A

Complete removal for moderate epithelial dysplasia by

  1. Surgical excision (Tissue preservation for histopathologic analysis)
  2. Electrocautery
  3. Cryosurgery
  4. Laser ablation
40
Q

What is Lichen Planus?

A

Immunologically mediated mucocutaneous disorder

Chronic T-cell mediated disorder of stratified squamous epithelium

41
Q

Pathogenesis of Lichen Planus

A

Keratinocyte apoptosis triggered by antigen-specific CD8+ cytotoxic T cells

42
Q

Demographics of Lichen Planus

A
  1. 30-60 years old
  2. Female
43
Q

Clinical Features of Reticular Lichen Planus

A
  1. Asymptomatic
  2. Bilateral posterior buccal mucosa
  3. Interlacing white lines called Wickham striae that wax and wane over weeks
44
Q

Clinical Features of Erosive Lichen Planus

A
  1. Symptomatic, sensitive to hot, acidic or spicy foods
  2. Atrophic, erythematous areas with central ulceration of varying degrees
  3. Periphery of atrophic regions bordered by fine, white radiating striae
  4. Confined to gingival mucosa → Desquamative gingivitis
45
Q

Clinical Features of Bullous Lichen Planus

A

Erosive component is severe such that epithelial separate from underlying CT

46
Q

Histopathologic Findings of Lichen Planus

A
  1. Intense, band-like infiltrate of predominantly lymphocytic infiltrate in the lamina propria
  2. Liquefactive necrosis degeneration in basal cell layer
  3. Absence of epithelial dysplasia and verrucous epithelial changes
  4. Saw-toothed rete ridges
47
Q

Differential Diagnosis of Lichen Planus

A
  1. Lichenoid drug reaction
  2. Lichenoid amalgam reaction
  3. Oral GVHD
  4. Lupus erythematous
48
Q

Management of Reticular Lichen Planus

A

No symptoms

Superimposed candidiasis treat with anti-fungals

49
Q

Management of Erosive Lichen Planus

A
  1. Topical corticosteroids to symptomatic areas
  2. Systemic corticosteroids only for severe, recalcitrant and widespread lichen planus
50
Q

General Management of Lichen Planus

A
  1. Establish diagnosis clinically and histology
  2. Establish presence of extra-oral lesion
  3. Establish current and past medical use
  4. Patient information and education
  5. Eliminate possible aggravating factors
  6. Avoid known carcinogens
51
Q

What are oral lichenoid drug reactions?

A

Lesions resembling OLP clinically and histologically but have an identifiable etiology

52
Q

Clinical Features of Oral Lichenoid Drug Reactions

A
  1. Unilateral lesions
  2. Atypical sites: Palate, labial mucosa, FOM
  3. Erosive lesions
  4. Extra-oral lesions
  5. Drug history: ACE inhibitors, beta blockers, NSAIDs, diuretics, methyldopa
53
Q

Management of Oral Lichenoid Drug Reaction

A
  1. Establish diagnosis
  2. Drug substitution or lower dose
  3. Topical corticosteroids
54
Q

What is an Oral Lichenoid Contact Lesion?

A

Lichenoid lesions with amalgam and other restorations adjacent to it

Coverage or removal of causative restorative material should result in resolution of lesion

55
Q

What is Oral Lichenoid Lesion of GVHD?

A

A condition that occurs after transfer of a graft (HSCT) in which immunocompetent T cells from donor attacks specific tissues in host

56
Q

Oral Findings Of Systemic/Discoid Lupus Erythematous

A
  1. Oral lesions 20%
  2. Lichenoid lesions on buccal, lips, palate, gingiva
  3. Discoid: Central atrophic area with radiating white striae
  4. Slit-like gingival ulcerations
  5. Sjogren’s syndrome
57
Q

Investigations of SLE

A

Serology test

58
Q

Management of SLE

A
  1. Potent topical corticosteroids
  2. Anti-mycotics
  3. Hydroxychloroquine
59
Q

What is Erythema Migrans/Geographic Tongue

A

Benign condition that primarily affects tongue

60
Q

Clinical Features of Geographic Tongue

A
  1. Anterior 2/3 of dorsal tongue
  2. Multiple, well-demarcated zones of erythema (atrophy of filiform papillae
  3. Surrounded by slightly elevated, white, scalloped border
  4. Asymptomatic but sometimes burning sensation to hot, spicy foods
61
Q

Histopathological Features of Geographic Tongue

A

Neutrophic infiltrate that is responsible for destruction of superficial epithelium

62
Q

Management of Geographic Tongue

A
  1. Generally no treatment
  2. If burning sensation, use topical corticosteroids to lesion areas several times a day
63
Q

What is Oral Hairy Leukoplakia?

A
  1. Related to EBV (HHV-4)
  2. Usually in HIV/AIDS patient as OHL is a sign of severe immunosuppression and advanced disease
  3. White mucosal plaque does not rub off
64
Q

Clinical Findings of Oral Hairy Leukoplakia

A
  1. Asymptomatic
  2. Non-removable, white, vertical, corrugated, hyperkeratotic lesion at lateral border of tongue
65
Q

Histopathologic Findings of Oral Hairy Leukoplakia

A
  1. Thickened parakeratin with surface corrugations
  2. Acanthotic epithelium with balloon cells in upper spinous layer
  3. Nuclear beading
  4. No dysplasia and inflammation noted
66
Q

Investigations for Oral Hairy Leukoplakia

A
  1. If patient has known HIV infection, clinical features is enough
  2. If not, we can do in-situ hybridisation, PCR, immunohistochemistry, southern blotting
67
Q

Management of Oral Hairy Leukoplakia

A

Treatment not needed although slight discomfort

Systemic anti-herpes viral drugs produce rapid resolution but recurrence is expected with discontinuation

68
Q
A

OMOPOR (7 decks)

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