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27 Cards in this Set

  • Front
  • Back
What is the definition of Leukoplakia? What are the consequences of this definition?
White patch of the oral mucosa that cannot be scraped off and cannot be diagnosed clinically or microscopically as any other condition

Clinical term ONLY, not a diagnosis. Biopsy is mandatory. Considered a premalignant process
DDx for a white lesion...
Leukoedema - goes away when skin stretched
Cheek chewing - narrow post, widens ant
Frictional keratosis - corregated surface
Nicotine stomatitis - post HP, raised nodules with red centre
Snuff-dippers keratosis
Aspirin burn
Lichen planus - bilateral
White Sponge Nevus
Cinnamon reaction
If a red component is present in a leukoplakia, what is it renamed?

What are the 3 surfaces leukoplakia can present with?
Speckled leukoplakia

Smooth, verrucous, micronodular
What is the epideimiology for Leukoplakia?
Older adult males, (>50 years), usually with hx of tobacco use.

Becoming more common in young males - marijuana?
What is the histology of Leukoplakia?
Some degree of hyperkeratosis, precancerous changes (mild, mod or severe dysplasia or carcinoma-in-situ)
What is the treatment for Leukoplakia?
No or mild dysplasia - decrease carcinogenic habits, monitor

Moderate or worse, remove
What is the prognosis of Leukoplakia?
15% of non-dysplastic lesions will transform if not treated

30% dysplastic lesions will transform

30% will recurr
What is a high risk presentation of Leukoplakia called?
Proliferative Verrucous Leukoplakia
What is Proliferative Verrucous Leukoplakia?
An uncommon, high risk presentation of Leukoplakia, female predilection (4:1), only a third have traditional risk factors.

Females ave 65 years
Males ave 49 years
What is the prognosis of Proliferative Verrucous Leukoplakia?
70% develop SCC within a mean follow-up of 8 years

40% had died as a result of carcinoma
What is the definition of Erythroplakia?
A red patch that cannot be diagnosed as any other condition clinically or microscopically.
What does Erythroplakia look like and where is it usually found?
velvety red, well demarcated patch, usually lateral tongue, FOM or soft palate
What is the epidemeology of Erythroplakia?
older males, carcincogenic risk factors
What is the usually histological appearance of Erythroplakia?
90% have severe epithelial dysplasia or worse at the time of biopsy.

Lack of keratin at surface = red appearance
What is the tx and prognosis?
Similar to that for leukoplakia with similar degree of epithelial dysplasia
What is Oral Submucous Fibrosis?
Chronic progressive scarring disease of the oral mucosa, seen primarily in India and Southeast Asia.

Associated with the habit of betal nut chewing
What is betal nut?
A combination of Areca nut, slaked lime, tobacco and spices wrapped in a betal leaf.

It is place in the buccal vestibule and the alkaloids from the nut are released and produce a mild euphoria.
How does Betel Nut cause Oral Submucous Fibrosis?
The alkaloid form the nut stimulate collagen synthesis (in susceptible patients), resulting in the formation of fibrous bands affecting the oral mucosa.
What is the result of Oral Submucous Fibrosis?
Trismus, Uvual atrophy, hyperkeratosis with epithelial atrophy and atypia, leukoplakia
What is the treatment for Oral Submucous Fibrosis?
Discontinue betel nut habit.

Intralesional corticosteroids may improve mild cases of trismus, but in the long term cause more fibrosis.

Severe cases may require surgical splitting of fibrous bands, with grafts and mouth props.

All should be biopsied
What does biopsy usually show in Oral Submucous Fibrosis?
10% show dysplasia at initial biopsy

Approximately 8% will undergo malignant transformation to SCC during a 10-year follow up period
What is Actinic Keratosis?
A premalignant sun-induced skin lesion (scaly plaque with sandpaper texture) that is common on facial skin and vermilion zone of lips in fair skinned persons over 40 years of age. Caused by UV light exposure.
What is the histology of Actinic Keratosis?
Hyperkeratosis, usually parakeratin

Some degree of epithelial dysplasia or even superficially invasive SCC seen
What is the Treatment for Actinic Keratosis?
Lesions tx with liquid nitrogen, surgical excision, laser ablation or 5-fluoro-uracil.
What is the prognosis for Actinic Keratosis?
Fair to good
What is Actinic Cheilosis?
Actinic keratosis involving the vermilion zone of the lower lip. Chronic scaling, crusting, ulceration and/or fissuring of the lip may be seen.
What is the tx for Actinic Cheilosis?
Vermilionectomy with advancement of the labial mucosa or laser ablation of the involved vermilion zone.