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114 Cards in this Set
- Front
- Back
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What is the most common benign epithelial neoplasm found on the oral mucosa?
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Oral Squamous Papilloma
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Define ORAL SQUAMOUS PAPILLOMA:
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a benign exophytic papillary proliferation of stratified squamous epithelium
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What are the main sites of predilection of ORAL SQUAMOUS PAPILLOMA?
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- tongue
- lips - soft palate/ uvula |
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What are the clinical features of ORAL SQUAMOUS PAPILLOMA?
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usually solitary
often pedunculated, sometimes sessile painless exophytic lesion with finger-like projections (cauliflower/wart-like appearance) |
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What is the treatment for ORAL SQUAMOUS PAPILLOMA?
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conservative excision including the base of the lesion
GOOD PROGNOSIS |
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Which virus is implicated in ORAL SQUAMOUS PAPILLOMA
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- Human papilloma virus HPV
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Define VERRUCA VULGARIS:
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a benign virus induced focal hyperplasia of stratified squamous epithelium
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Which viruses are associated in VERRUCA VULGARIS?
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HPV types 2, 4, 6 , and 40
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VERRUCA VULGARIS spreads by:
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autoinoculation
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What is the treatment of VERRUCA VULGARIS?
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Oral lesions are surgically excised including the base of the lesion
They may be destroyed with cryotherapy |
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VERRUCA VULGARIS occurs more commonly on:
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skin of the hand
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Define CONDYLOMA ACUMINATUM:
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A benign virus induced proliferation of stratified squamous epithelium in the anogenital region, but may also involve oral epithelium.
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What is the incubation period for CONDYLOMA ACUMINATUM?
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1 to 3 months
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What are the clinical features of CONDYLOMA ACUMINATUM?
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a sessile
plaque like lesion fine papillary / cauliflower like surface multiple and clustered |
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List the conditions that are associated with HPV:
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- verruca vulgaris (common wart)
- oral squamous papilloma - condyloma acuminatum (venereal wart) - focal epithelial hyperplasia (Heck's disease) |
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What are the clinical features of FOCAL EPITHELIAL HYPERPLASIA?
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- asympto
- multiple soft plaques - flattened or rounded papules - usually clustered - normal mucosa colour - cobblestone or fissured appearance when clustered together |
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What is the treatment for FOCAL EPITHELIAL HYPERPLASIA?
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surgical excision is done for diagnostic and aesthetic purposes
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Define VERRUCIFORM XANTHOMA
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Hyperplastic condition of the epithelium of the mouth, skin and genitalia with a characteristic accumulation of lipid-laden histiocytes beneath the epithelium.
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What are the most common sites of VERRUCIFORM XANTHOMA?
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- gingiva
- alveolar mucosa |
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What are the clinical features of VERRUCIFORM XANTHOMA?
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- well demarcated
- soft, painless - sessile elevated mass - white, yellow-white or red colour - papillary or roughened "verruciform" surface |
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Define ORAL MELANOCYTIC MACULE?
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focal increase in melanin deposition and possibly an increase in melanocytes
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What is the etiologic cause of ORAL MELANOCYTIC MACULE?
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unclear
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What is the clinical features of ORAL MELANOCYTIC MACULE?
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typically solitary occasionally multiple well demarcated uniformly tan to dark brown round or oval macules
asymptomatic |
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ALL of which kind of lesions should be excised and examined histopathologically?
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- oral pigmented macules of recent onset
- large size - irregular pigmentation - uknown duration - recent enlargement |
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What is the treatment for LABIAL MELANOTIC MACULE?
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No treatment except for aesthetic considerations
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What is the treatment for ORAL MELANOTIC MACULE?
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no malignancy potential but should be biopsied because early melanoma has similar appearance
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Define ORAL MELANOACANTHOMA:
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a benign an uncommon acquired pigmentation of the oral mucosa
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What population is ORAL MELANOACANTHOMA mainly in?
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exclusively in black
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What is the most common site of ORAL MELANOACANTHOMA?
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buccal mucosa
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What are the clinical features of ORAL MELANOACANTHOMA?
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- dark brown to black macule
- increase in size |
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What is ACQUIRED MELANOCYTIC NEVUS?
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common benign growths of nevus cells
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What do nevus cells develop from?
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neural crest origin
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What are the THREE types of NEVUS?
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- junctional nevus
- compound nevus - intradermal nevus |
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What is the treatment for VERRUCIFORM XANTHOMA?
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Conservative surgical excision
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Define KERATOACANTHOMA:
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self-limiting epithelial proliferation with strong clinical and histo similarity to differentiated squamous cell carcinoma
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What are the three phases of KERATOACANTHOMA?
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- growth phase: rapid growth, 1-2cm in 6 weeks. Firm, nontender, sessile nodule, with central keratin plug
- stationary phase: stabilizes for about 6 weeks - involution phase: regress spontaneously within 6-12 months, frequently leaving depressed scar in area |
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What is the treatment of KERATOACANTHOMA?
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surgical excision
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Define BLUE NEVUS:
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an uncommon, benign proliferation of dermal melanocytes, usually deep within subepithelial connective tissue that affects skin and mucosa
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What are the two types of BLUE NEVUS?
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- common
- cellular |
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Oral lesions of BLUE NEVUS are most frequently seen where?
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palate
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What is the treatment of BLUE NEVUS?
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Simple surgical excision and good prognosis.
Biopsy is advised since it clinically can mimic an early melanoma |
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Define NICOTINE STOMATITIS:
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a white keratotic change of the hard palate associated with tobacco smoking
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What is the treatment for NICOTINE STOMATITIS:
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- it is completely reversible
- palate returns to normal - usually in 1 to 2 weeks after smoking cessation - any white lesion of the palatal mucosa that persists after 1 month of habit cessation |
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Identify the benign epithelial lesion:
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ORAL SQUAMOUS PAPILLOMA
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Identify the benign epithelial lesion:
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ORAL SQUAMOUS PAPILLOMA
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Identify the benign epithelial lesion:
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ORAL SQUAMOUS PAPILLOMA
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Identify the benign epithelial lesion:
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ORAL SQUAMOUS PAPILLOMA
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Identify the benign epithelial lesion:
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ORAL SQUAMOUS PAPILLOMA
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Identify the benign epithelial lesion:
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ORAL SQUAMOUS PAPILLOMA
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Identify the benign epithelial lesion:
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ORAL SQUAMOUS PAPILLOMA
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Identify the benign epithelial lesion:
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ORAL SQUAMOUS PAPILLOMA
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Identify the benign epithelial lesion:
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ORAL SQUAMOUS PAPILLOMA
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Identify the benign epithelial lesion:
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VERRUCA VULGARIS
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Identify the benign epithelial lesion:
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VERRUCA VULGARIS
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Identify the benign epithelial lesion:
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VERRUCA VULGARIS
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Identify the benign epithelial lesion:
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FOCAL EPITHELIAL HYPERPLASIA (Heck's Disease)
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Identify the benign epithelial lesion:
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FOCAL EPITHELIAL HYPERPLASIA (Heck's Disease)
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Identify the benign epithelial lesion:
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FOCAL EPITHELIAL HYPERPLASIA (Heck's Disease)
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Identify the benign epithelial lesion:
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FOCAL EPITHELIAL HYPERPLASIA (Heck's Disease)
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Identify the benign epithelial lesion:
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FOCAL EPITHELIAL HYPERPLASIA (Heck's Disease)
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Identify the benign epithelial lesion:
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FOCAL EPITHELIAL HYPERPLASIA (Heck's Disease)
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Identify the benign epithelial lesion:
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FOCAL EPITHELIAL HYPERPLASIA (Heck's Disease)
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Identify the benign epithelial lesion:
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FOCAL EPITHELIAL HYPERPLASIA (Heck's Disease)
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Identify the benign epithelial lesion:
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VERRUCIFORM XANTHOMA
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Identify the benign epithelial lesion:
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VERRUCIFORM XANTHOMA
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Identify the benign epithelial lesion:
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ORAL MELANOTIC MACULE
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Identify the benign epithelial lesion:
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ORAL MELANOTIC MACULE
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Identify the benign epithelial lesion:
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ORAL MELANOTIC MACULE
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Identify the benign epithelial lesion:
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ORAL MELANOTIC MACULE
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Identify the benign epithelial lesion:
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ORAL MELANOTIC MACULE
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Identify the benign epithelial lesion:
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ORAL MELANOTIC MACULE
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Identify the benign epithelial lesion:
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ORAL MELANOTIC MACULE
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Identify the benign epithelial lesion:
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ORAL MELANOTIC MACULE
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Identify the benign epithelial lesion:
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ORAL MELANOACANTHOMA
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Identify the benign epithelial lesion:
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ACQUIRED MELANOCYTIC NEVUS
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Identify the benign epithelial lesion:
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ACQUIRED MELANOCYTIC NEVUS
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Identify the benign epithelial lesion:
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BLUE NEVUS
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Identify the benign epithelial lesion:
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BLUE NEVUS
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Identify the benign epithelial lesion:
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BLUE NEVUS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Identify the benign epithelial lesion:
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NICOTINIC STOMATITIS
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Define "PRECANCEROUS LESION"
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a benign, morphologically altered tissue that has a greater than normal risk of malignant transformation
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Define "PRECANCEROUS CONDITION"
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a disease or patient habit that does not necessarily alter the clinical appearance of local tissue but is associated with a greater than normal risk of precancerous lesion or cancer development in that tissue
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Define MALIGNANT TRANSFORMATION POTENTIAL
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the risk of cancer being present in a pre-cancerous lesion or condition, either at initial diagnosis or in the future
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Define ACTINIC KERATOSIS:
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a common cutaneous pre-malignant lesion that is caused by cumulative UV radiation to sun-exposed skin, especially in fair-skinned people
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Where are the most common sites for ACTINIC KERATOSIS?
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- face and neck
- dorsum of hands and forearms - scalp of bald headed men |
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Describe the clinical features of lesions of ACTINIC KERATOSIS:
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irregular scaly, white, gray, brown, plaques
may be within erythematous background palpation of lesion reveals a "sandpaper" roughened texture |
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What is the treatment of ACTINIC KERATOSIS?
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- removal by liquid nitrogen cryotherapy, topical 5FU, curettage, surgical excision, electrodessication
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What percentage of ACTINIC KERATOSIS is estimated to progress to squamous cell carcinoma in high risk populations?
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10% approx. over 2 years
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Define ACTINIC CHEILOSIS
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common premalignant alteration of the lower lip vermillion produced by long-term or excessive exposure to sunlight
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What are the clinical features of ACTINIC CHEILOSIS?
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- atrophy of lower lip vermillion border
- blurring of the interface between vermillion zone and skin of the lip - rough scaly areas may thicken appearing as leukoplakia |
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What is the treatment of ACTINIC CHEILOSIS?
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- prevention: use of lip balms with sunscreen
- areas of INDURATION, THICKENING, or LEUKOPLAKIA should - long term follow up |
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Define LEUKOPLAKIA:
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a white patch or plaque that DOES NOT WIPE OFF and CANNOT BE DIAGNOSED CLINICALLY or PATHOLOGICALLY as any other disease
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What is the MOST COMMON of the oral precancer?
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LEUKOPLAKIA
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What is the demographic for LEUKOPLAKIA?
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- older than 40 years
- prevalence increases with age - male |
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Where are most LEUKOPLAKIAS found?
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70% on lip vermillion, buccal mucosa and gingiva
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Which conditions must be ruled out before a clinical diagnosis of LEUKOPLAKIA can be made?
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- lichen planus
- morsicatio - frictional keratosis - tobacco pouch keratosis - nicotine stomatitis - leukoedema - white spongy nevus |
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What are some histologic changes for LEUKOPLAKIA?
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- hyperkeratosis: thickened layer of stratum corneum composed of orthokeratin (non-nucleated keratin) and parakeratin (residual nuclei) or both
- ACANTHOSIS: increased thickness of intermediate cell layer |
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Define ORTHOKERATIN:
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non-nucleated keratin
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Define ACANTHOSIS:
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increased thickness of the intermediate cell layer
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What are some INDIVIDUAL CELL ALTERATIONS in epithelial dysplasia?
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- prominent nucleoli
- hyperchromatic nuclei - nuclear and cellular pleomorphism - altered nuclear/cytoplasmic ratio - increased mitotic activity - multinucleation of cells - individual cell keratinization |
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Define EPITHELIAL DYSPLASIA:
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premalignant change in epithelium characterized by a combination of individual cell and architectural alterations
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What are the different stages of severity of EPITHELIAL DYSPLASIA?
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MILD: alterations limited principally to basal and parabasal layers
MODERATE: alterations from basal layer to the midportion of the spinous layer SEVERE: alterations from basal layer to level above the midpoint of epithelium |
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Define CARCINOMA IN SITU:
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the most severe stage of EPITHELIAL DYSPLASIA, involving the entire thickness of epithelium without invasion
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What is the management of LEUKOPLAKIA?
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- First step to achieve definitive histopathologic diagnosis via BIOPSY
- remove all irritants such as tobacco, alcohol, etc - tissue taken from clinically most severe areas, and multiple areas preferably - clinical evaluation every 6 months is recommended becasue of the possibility of progression toward epithelial dysplasia |
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Which factors INCREASE the risk for cancer in LEUKOPLAKIC lesions?
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- persistence over several years
- occurence in FEMALE patient - occurence in NONSMOKER - ORAL FLOOR or VENTRAL TONGUE |
