oral potentially malignant disorders Flashcards

1
Q

what is an OPMD

A

group of lesions and conditions in oral mucosa that display increased risk of malignant transformation

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2
Q

name 3 (4) OPMDs

A

leukoplakia
(proliferative veruccous leukoplakia)
oral erythroplakia
oral submucous fibrosis

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3
Q

oral leukoplakia
- epidemiology
- clinical features
- histology

A

epidemiology: 6x more prevalent in smokers, 2% prevalence gloabally
clinical: white lesion that cannot be scraped off
histology: various degrees of keratinisation, dysplasia may or may not be present

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4
Q

proliferative veruccous leukoplakia
- epidemiology
- clinical features

A

epi: F>M, elderly
clinical: veruccous, non homogenous appearance, resistant to treatment, high recurrence

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5
Q

oral erythroplakia
- epidemiology
- clinical features
- histology

A

epi: 50s-60s, 0.2%
clinical: flat or slightly depressed red patch, common sites = FOM, lateral tongue and soft palate
histology: epithelial dysplasia is common

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6
Q

oral submucous fibrosis
- epidemiology
- clinical features
- histology

A

epi: south asia and india, areca nut/betel quid, 10s-30s
clinical - progressive fibrosis of submucosal tissues - burning, stiffness, limited mouth opening, blanching
histology: fibrosis and hyalinisation in lamina propria

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7
Q

name 4 clinical risk factors of a lesion for malignancy

A

size - >200mm2
site - lateral tongue, soft palate, FOM
texture - non homogenous
colour - red or speckled

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8
Q

name 4 patient risk factors for malignant change

A

50+
female
drinks alcohol
previous head and neck cancer

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9
Q

what is dysplasia

A

abnormal cells or abnormal cell changes within a tissue

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10
Q

how is dysplasia graded

A

mild - lower 1/3 only
moderate - middle 1/3
severe - more than 2/3
carcinoma in situ - full thickness affected

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11
Q

name 4 architectural features of epithelial dysplasia

A

loss of polarity of basal cells
loss of epithelial cell cohesion
increased number of mitotic figures
drop shaped rete ridges

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12
Q

name 4 cellular features of epithelial dysplasia

A

abnormal mitotic figures
nuclear pleomorphism
cellular pleomorphism
hyperchromatism

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13
Q

screening

A

tool to identify a developing cancer in a patient who may have increased risk

early detection is vital for decreasing morbidity and mortality

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14
Q

discuss vital staining with toluidine blue

A

screening aid for OPMDs
tolonium chloride as metachromatic dye
mucosa rinsed with acetic acid twice then dye applied
binding of blue dye means positive result

(significant number of false positives, may be used to help choose biopsy site)

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15
Q

optical fluorescence imaging

A

e.g VELscope
disruption to tissue morphology in dysplasia and cancer alters their fluorescence
normal tissues will appear bright green, abnormal tissues dark green

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16
Q

oral brush cytology

A

minimally invasive approach for harvesting cells
requires good technique to ensure cells from each layer are harvested

17
Q

is there any pharmaceutical medications for OPMDs (to prevent progression to malignancy)

A

no - no robust evidence
systemic vitamin A and NSAIDs have been suggested

18
Q

surgical treatment of OPMDs

A

1st choice treatment is excision with cold steel
full excision of OPMD with few mm margin

if malignancy 1cm margin required