oral potentially malignant disorders Flashcards
what is an OPMD
group of lesions and conditions in oral mucosa that display increased risk of malignant transformation
name 3 (4) OPMDs
leukoplakia
(proliferative veruccous leukoplakia)
oral erythroplakia
oral submucous fibrosis
oral leukoplakia
- epidemiology
- clinical features
- histology
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
proliferative veruccous leukoplakia
- epidemiology
- clinical features
epi: F>M, elderly
clinical: veruccous, non homogenous appearance, resistant to treatment, high recurrence
oral erythroplakia
- epidemiology
- clinical features
- histology
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
oral submucous fibrosis
- epidemiology
- clinical features
- histology
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
name 4 clinical risk factors of a lesion for malignancy
size - >200mm2
site - lateral tongue, soft palate, FOM
texture - non homogenous
colour - red or speckled
name 4 patient risk factors for malignant change
50+
female
drinks alcohol
previous head and neck cancer
what is dysplasia
abnormal cells or abnormal cell changes within a tissue
how is dysplasia graded
mild - lower 1/3 only
moderate - middle 1/3
severe - more than 2/3
carcinoma in situ - full thickness affected
name 4 architectural features of epithelial dysplasia
loss of polarity of basal cells
loss of epithelial cell cohesion
increased number of mitotic figures
drop shaped rete ridges
name 4 cellular features of epithelial dysplasia
abnormal mitotic figures
nuclear pleomorphism
cellular pleomorphism
hyperchromatism
screening
tool to identify a developing cancer in a patient who may have increased risk
early detection is vital for decreasing morbidity and mortality
discuss vital staining with toluidine blue
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)
optical fluorescence imaging
e.g VELscope
disruption to tissue morphology in dysplasia and cancer alters their fluorescence
normal tissues will appear bright green, abnormal tissues dark green