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59 Cards in this Set
- Front
- Back
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Why do white lesions appear white? (6)
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- diminished role of blood vessels
- thickened keratin layer (hyperkeratosis) - thickened spinous layer (hyperplasia) - membrane/plaque covering mucosa - epithelial fluid accumulation - epithelial alteration |
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List four white lesions that can be scraped off
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- pseudomembranous candidiasis
- burn injury - sloughing traumatic lesion - toothpaste/mouthwash rxn |
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List the developmental white lesions (2)
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fordyce granules
leukoedema |
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List the infectious white lesions (5)
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candidiasis
squamous papilloma / verruca vulgaris mucous patch oral hairy leukoplakia scarlet fever |
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list the immune-mediated white lesions (3)
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lichen planus / lichenoid mucositis
geographic tongue lupus |
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list the reactive white lesions (6)
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linea alba
nicotine stomatitis white coated tongue burn injuries frictional hyperkeratosis smokeless tobacco keratosis |
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list the genodermatoses (6)
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white sponge nevus
hereditary bening intraepithelial dyskeratosis pachyonchia congenita dyskeratosis congenita xeroderma pigmentosa darier's disease / warty dyskeratoma |
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list the neoplastic white lesions (2)
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epithelial dysplasia
squamous cell carcinoma |
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trauma-induced white plaque resulting from chronic mechanical irritation
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frictional hyperkeratosis
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frictinal hyperkeratosis:
clinical features (3) |
well-defined white plaque roughened keratotic surface
frequently seen on alveolar ridge |
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frictional hyperkeratosis:
histo features |
epithelial hyperkeratosis
w/ or w/out epithelial hyperplasia |
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frictional hyperkeratosis:
treatment |
biopsy (rule out pre-malignancy)
eliminate irritation source topical steroids |
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smokeless tobacco:
frequency of use carcinoma risk development time |
6% of men
four-fold increased carcinoma risk up to 15 years to develop |
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smokeless tobacco keratosis:
clinical features |
males
loss of gingiva/periodontal tissues in contact area gray/white translucent plaque w/ indistinct borders / ridging mucosa "velvety" mucosa |
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smokeless tobacco keratosis:
histo features |
hyperkeratotic / acanthotic epi
epithelial dysplasia (maybe) non-specific |
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smokeless tobacco keratosis:
treatment |
cessation of tobacco use
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list the genodermatoses (5)
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white sponge nevus
hereditary benign intraepithelial dyskeratosis pachyonchia congenita dyskeratosis congenita darier's disease / warty dyskeratosis |
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white sponge nevus:
inheritance aka penetrance / expressivity defect of |
autosomal dominant
Cannon's disease high penetrance/variable expressivity defect of keratinization in mucosa (keratin 4 or 13) |
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white sponge nevus:
clinical features |
lesions appear at birth or early childhood
symmetric, thick, white, velvety plaques on BILATERAL buccal mucosa or other mucosal surfaces |
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white sponge nevus:
histo features |
prominent hyperkeratosis / acanthosis
clearing of cytoplasm in spinous layer peri-nuclear eosinophilic condensation in superficial epithelium cytologic smear better than H&E for seeing pre-nuc condensation |
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white sponge nevus:
treatment |
none, good prognosis
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hereditary benign intraepithelial dyskeratosis (HBID):
aka inheritance population |
Wiktop-Von Sallmann syndrome
autosomal dominant tri-racial NC isolate (native-american, african-american, white) |
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HBID:
clinical features |
develops in childhood
eyes / oral mucosa involved thick, corrugated white plaques on buccal / labial mucosa plaques prominent in spring, regress in summer blindness may occur |
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HBID:
histo features |
parakeratin
acanthosis "cell within a cell" appearance of epithelial cells |
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HBID:
treatment |
no tx
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pachyonchia congenita:
discuss two types |
Jadassohn-Lewandowsky Type
- keratin 16 mutation - oral lesions Jackson-Lawler Type - keratin 17 mutation - WITHOUT oral lesions |
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pachyonchia congenita:
clinical features |
- free margin of nails lifted up (due to keratinaceous accumulation)
- hyperkeratosis of palmar/plantar surfaces - painful blisters on soles of feet - ORAL LESIONS: thick white plaques involving lateral and dorsal tongue surfaces - possible laryngeal involvement --> hoarsness and dyspnea |
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packyonchia congenita:
histo features (oral lesions) |
hyperparakeratosis
acanthosis peri-nuclear clearing of epithelial cells |
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pachyonchia congenita:
treatment of oral lesions |
no tx
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dyskeratosis congenita:
aka inheritance susceptibility |
Cole-Engman / Zinsser-Cole syndrome
X-linked recessive (DKS 1 mutation) susceptible to aplastic anemia / SSC |
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dyskeratosis congenita:
clinical features (6) |
evident by age 10
hyperpigmentation of face/neck/chest dysplastic nail changes tongue/buccal mucosa bullae, erosions, leukoplakias (33% --> malignant) periodontal disease mild mental retardation |
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dyskeratosis congenita:
histo features |
hyperorthokeratosis w/ epithelial atrophy
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dyskeratosis congentia:
treatment / prognosis |
follow-up for malignant transformation
evaluate for aplastic anemia lifespan if severely affected = 32 years |
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xeroderma pigmentosa:
inheritance cause prevalence |
autosomal recessive
defect in DNA repair (light-induced damage causes excessive skin cancer) 1/250,000 |
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xeroderma pigmentosa:
clinical features |
multiple cutaneous malignancies
SCC of lower lip/tongue tip tendency to sunburn skin changes in early childhood: actinic keratosis, BCC/SCC before 10 yo --> melanoma in 5% below normal intelligence |
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xeroderma pigmentosa:
treatment |
topical chemo (5-FU) for AKS
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darier disease:
inheritance cause prevalence |
autosomal dominant (high penetrance)
mutation in gene for intracellular Ca pump 1/36-100,000 in US |
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darier disease:
clinical features (non-oral, 6) |
erythematous, pruritic papules on skin of trunk/scalp
age 10-20 develops keratin accumulation --> rough texture foul odor (bacterial degradation of keratin) worse in summer lines, ridges, splits in nails |
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darier disease:
clinical features (oral) |
appear in 15-50% of cases
asymptomatic normal-colored/white papules cobblestone appearance hard palate or alveolar mucosa may have parotid swelling due to duct abnormality/obstruction |
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darier disease:
histo features |
central keratin plug overlying epithelium w/ suprabasilar cleft
narrow, long rete ridges Corps ronds (round bodies) Corps grains (resemble cereal grains) |
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darier disease:
treatment |
no tx
sunscreen |
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warty dyskeratoma:
clinical features |
focal acantholytic dyskeratosis
isolated Darier disease solitary asymptomatic papule of skin/oral mucosa unknown cause males > 40 hard palate or ridge |
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warty dyskeratosis:
histo features |
dyskeratosis
suprabasilar cleft |
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warty dyskeratosis:
treatment / prognosis |
conservative excision
does not recur no malignant potential |
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list the neoplastic white lesions (2)
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epithelial dysplasia
SSC |
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leukoplakia:
diagnosis description population affected |
diagnosis of exclusion (not definitive)
simply a white plaque 5-25% --> dysplasia most common presentation of oral malignant lesions (85%) 3% of caucasian adults male predilection (70%) |
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leukoplakia:
etiology |
tobacco
alcohol UV radiation microorganisms trauma |
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leukoplakia:
clincal features |
males > 40 (avg age = 60)
70% on lip, buccal mucosa, gingiva 90% of DYSPLASTIC lesions are on tongue, lip, floor of mouth |
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leukoplakia:
mild/thin vs. homogenous/thick vs. granular/nodular |
mild/thin = rarely dysplastic
homogenous/thick = leathery with fissures |
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leukoplakia:
proliferative verrucous leukoplakia |
multifocal premalignant lesions w/ persistent growth
develops into SCCa / verrucous carcinoma within 8 years 4:1 females multiple keratotic plaques with roughened projections |
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leukoplakia:
histo features |
increased nuc:cyto ratio
prominent nucleoli pleomorphic nuclei/cells hyperchromatic nuclei mitotic figures dyskeratosis bulbous rete ridges |
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epithelial dysplasia:
mild moderate severe ca-in-situe |
mild - involves up to lower 1/3 of epi
moderate - involves up to lower 2/3 of epi severe - involves greater than 2/3 of the epi ca-in-situ - full thickness of epi |
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leukoplakia:
breakdown of clinical features/diagnosis |
80% hyperkeratosis +/- hyperplasia
12% mild to moderate dysplasia 4% severe dysplasia or ca-in-situ 3% SCC |
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leukoplakia:
treatment |
biopsy required
if dysplasia --> remove causative factors/remove lesion |
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nicotine stomatitis:
clinical |
smokers (esp pipes/cigars)
related to heat exposure not pre-malignant hyperkeratotic (white) palate w/ red papules (inflamed minor salivatory glands) |
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nicotine stomatitis:
histo features |
hyperkeratosis
acanthosis (thick spinous layer) |
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inflammatory papillary hyperplasia:
clinical |
over-wearing dentures
seen on hard palate below denture base pink/white/red pebbly in appearance possible candida superinfection |
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inflammatory papillary hyperplasia:
histo features |
pseudoepitheliomatous hyperplasia
salivary gland inflammation inflammatory cells subjacent to epi, islands of squamous epi (rete ridge abnormalities) |
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inflammatory papillary hyperplasia:
treatment |
denture therapy
antifungal excision of hyperplastic tissue |
