suspicious oro-mucosal lesions

Question 1

what is being suspicious?

Answer 1

causing one to have the impression that something is questionable, dishonest, or dangerous

Question 2

features of suspicious lesions?

Answer 2

more likely to be sinister -
> solitary ulcer
> present for >3weeks
> unintended weight loss
> rolled margins
> bleeding on light touch
> firm or fixed lesions
> numbness
> red or speckled lesions
> severe or extensive ulceration
> other associated lesions or symptoms (neck lump)

Question 3

what can cause oral ulceration?

Answer 3

> neoplasia (scc)
trauma
RAS
oral infections
systemic disease - GI, haematological, skin, rheumatological
drugs e.g nicorandil

Question 4

how does syphilis present?

Answer 4

ulceration in dorsal of the tongue
unusual appearance
noise erythema
“snail track” ulcer
erythema migrans

Question 5

ulceration related to systemic diseases?

Answer 5

anaemia
bowel disease - ulcerative colitis (pyostomatitis vegetans/ chrons (cobble stoning)
leukaemia (markers pupura)
HIV
granulomatous conditions
agranulocytosis (neutropenia) (neutropenic ulceration)
langerhans cell histocytosis

Question 6

vesiculobullous disease examples?

Answer 6

pemphigus
pemphigoid (more intense)
desquamative gingivitis

Question 7

what are the categories of white lesions?

Answer 7

hereditary
>eg white sponge naevus

Acquired
> infective - candidosis
> non-infective - leukoplakia - frictional keratosis, cheek/ tongue chewing, oral epithelial dysplasia, SCC

others - oral lichen planus, discoid lupus erythematosis, skin grafts

Question 8

what are the categories of red patches?

Answer 8

acquired
>infective - denture - induced erythematous candidosis
>non-infective - oral epithelial dysplasia/ scc, trauma eg burn

other
> lichen plants
> discoid lupus erythematosis
> erythema migrans (geographic tongue)

Question 9

what must you always do with erythroplakia?

Answer 9

biopsy
as over 50% contain severe dysplasia

Question 10

ininitial managment in primary care?

Answer 10

> recognise abnormal mucosa
identify potential causative factor and eliminate if possible (eg sharp tooth)
clinical photography
refer to secondary care if suspicious/ unusual

Question 11

initial managment in secondary care?

Answer 11

> history and examination
clinical photography
additional investigations eg swabs/ radiographs/ bloods as indicated
biopsy (incisional vs excisional)
review with results and manage accordingly

Question 12

what are the cancer research referral guidelines 2015?

Answer 12

> unexplained ulceration in the oral cavity (lasting more than 3 weeks)
lump on the lip or in the oral cavity consistent with oral cancer
persistent unexplained lump in the neck
red or red and white patch consistent with erythroplakia or erythroleukoplakia