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24 Cards in this Set
- Front
- Back
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Skin masses presenting as swellings in the neck
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Main categories
- Inflammatory. Most common - Neoplastic. Second most common - Developmental Inflammatory/Infections - Furuncle, MRSA Benign - Dermoid cyst, Lipoma Malignant - Carcinoma, Adnexal tumor |
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Inflammatory lesions
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Most common cause of neck swelling - 50%
- Viral: CMV, Mono - Bacterial: Paratid sialadenitis, Odontogenic - Parasitic: Toxoplasmosis - Granulomatous: Sarcoidosis, Scrofula - Acute or chronic lymphadenititis |
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Neoplastic lesions
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Second most common
Tumors of parotid Lymphoma Metastatic lesions which may present with an unknown primary lesion |
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Developmental lesions
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- Lateral cervical (Branchial Cleft) cyst
- Epidermoid cyst - Dermoid cyst - Thyroglossal duct cyst |
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Most common Neoplastic pediatric neck masses
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Lymphoma - 50% of all pediatric neck masses. 25% NHL and 25% HL
Thyroid cancer Neuroblastoma Nasopharyngeal carcinoma Alveolar soft part sarcoma |
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Rule of 80
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Pertains to lateral neck masses in patients 40 years or older
- Of neck masses, 80% are neoplastic - Of Neoplastic, 80% are malignant - Of Malignant, 80% are secondary - Of Secondary, 80% are above the Clavicle |
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Rule of 7
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Pertains to duration of syptoms
7 days - Most likely inflammatory 7 months - Neoplastic 7 years - Developmental |
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Biopsy of Neck masses
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Fine needle aspiration
- Needle can be radiographically guided or free hand - Aspiration of liquid or solid tumor Lymph node/ Mass surgical biopsy - Surgical removal of all or part of mass. Surgical specimen - Decision is dependent on site involved |
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Common Locations for Parotid gland tumors
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Usually lie on or behind the angle of mandible
- Grows slowly over months or years |
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Six basic steps
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Neck - Lymph nodes, Thyroid, TMJ
Lips and Cheeks - Visualize, palpate, milk parotid Tongue - Visualize base of tongue, Palpate Floor of mouth - Bimanually palpate Palate - Visualize and palpate Oropharynx - Tonsillar pillars, post pharyngeal wall |
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Oropharyngeal Cancer Statistics
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- 30,000 new cases yearly
- 8000 die yearly more than Melanoma and Cervical cancer combined - More common than Leukemia, HL, brain, stomach, ovarian, thyroid, renal, pancreatic, and esophageal cancer - Overall 5 year survival is 50% - Mortality unchanged for 50 years |
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Challenge of Early Detection
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- 5% to 15% of all dental patients have an oral abnormality like mucosal change
- Vast majority are truly benigh - Detecting those that are precancerous and cancerous is the key to improving survival of oral cancer patients |
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Difficulty with oral cancer screening
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Classic features of invasive oral cancer - Ulceration, fixation, nodularity, and large size are features of advanced lesions, not early ones
Precancerous and early cancerous lesions may appear identical to common, benign-looking lesions with no distinctive features Can't clinically tell the difference between Hyperkeratosis and Dysplasia |
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Clinical trial for oral cancer
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- Among lesions judged to be innocuous on clinical inspection 4.5% were found to be precancer or cancer
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OralCDx Test Kit Components
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- Oral brush biopsy instrument
- Precoded glass slide and matching coded test requisition form - Alcohol/Carbowax fixative pouch - Preaddressed container for submitting contents - Claims to be a complete transepithelial specimen versus superficial specimen with conventional cytologic smear |
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Indications and Contraindications of brush biopsy
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Indications: Epithelial abnormalities
- Leukoplakia, Erythroplakia, Atrophic mucosa, thickened, traumatized, or irritated Contraindications - Highly suspicious lesions that should undergo immediate scalpel biopsy - Lesions found in high risk areas - Lesions that are submucosal with intact epithelium - Ulcerations |
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If you are suspicious of a Mucosal leukoplakia
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- Remove possible irritant
- Wait 10-14days to see if it resolves - If still present, scalpel biopsy high risk sites, and brush biopsy, viziLite or VELScope and close long term followup of low risk sites |
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Brush Biopsy Technique
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- No Topical or Local is required
- Slightly moisten brush with water or patient's saliva - If too wet, dry off. - Apply firm pressure against surface of lesion while rotating 5-10 times. More turns with thicker leukoplakia or hyperkeratosis - Pink tissue or microbleeding indicates that the brush has penetrated to the desired depth at the Basement Membrane |
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Slide Preparation Procedure
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- Tear open fixative package prior to performing brush biopsy
- Cellular material on brush must immediately be spread on the enclosed glass slide - Spread fixative material onto the glass slide - Let dry 15-20 min and slide will be ready for shipment |
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OralCDx Results Classification
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Normal - Negative with no cellular abnormalities
Abnormal - Positive: Definitive cellular evidence of dysplasia or carcinoma. Require scalpel biopsy - Atypical: Abnormal epithelial changes warranting further investigation. Require scalpel biopsy - Does not substitute for a scalpel biopsy but identifies which lesions require histological evaluation - All negative lesions require same careful clinical follow-up as negative histologically sampled lesions |
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OralCDx studies
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- False negative rate of about 3.5%
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VelScope
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-Normal tissue should be pale green
- SCCa should be dark green or black |
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ViziLite with TBlue630
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TBlue630 is a patented toluidine blue-based metachromatic dye
- Use with Chemiluminescent light source from ViziLite to improve identification of lesions - Normal epithelium absorbs Vizilite and appears dark - Abnormal reflects and appears white |
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High risk areas
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Venteral and lateral tongue
FOM Posterior SP/Tonsillar pillar |
