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Oral med > DIFFERENTIAL DIAGNOSIS OF RED, WHITE AND PIGmented lesions > Flashcards

DIFFERENTIAL DIAGNOSIS OF RED, WHITE AND PIGmented lesions Flashcards

1
Q

Main causes of red lesions in the mouth?

A
  • VASCULAR
  • INFLAMMATORY
  • PURPURA
  • EROSIVE
  • REACTIVE
  • ATROPHIC
  • NEOPLASMS
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2
Q

Inflammatory causes of red white and pigmented lesions?

A
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3
Q

what is this picture of?

A

Herpes simplex virus

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4
Q

what is this?

A

Herpes zoster

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5
Q

what does this show?

A

Candida

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6
Q

what stain is this and what does it show?

A

PAS/d and it shows the candida hyphae

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7
Q

What does this show?

A

Granular gingivitis

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8
Q

what is this?

A

This is a reactive lesion

Pyogenic granuloma

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9
Q

What are the erosive causes of red lesions?

A
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10
Q

what does this show?

A

Aspirin burn

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11
Q

what is this?

A

Pemphigoid lesion

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12
Q

what is this?

A

Pemphigus

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13
Q

what are the atrophic causes of red lesions?

A

Erythema migrans

Atrophic Lichen planus

Iron deficiency–> glossitis

Erythroplasia

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14
Q

What is this?

A

Erythema migrans or Geographic tongue

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15
Q

what is this?

A

Erythroplasia

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16
Q

what causes purpura?

A

Trauma

Platelet disorders

Angina Bullosa heamorrhagica

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17
Q

what is this?

A

Purpura

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18
Q

what are the vascular anomalies which can cause red, white or pigmented lesions?

A

Lingual varices

telengiectasias

heamangiomas

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19
Q

what is this?

A

HAEMANGIOMA/ TELENGIECTASIA

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20
Q

what is a capillary heamangioma?

A

Capillary haemangioma may involve any intraoral area of mucosa with the mucosal aspect of the lower lip being a favourite site.

Direct pressure applied to the lesion will reveal blanching as opposed to the pigmented lesion.

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21
Q

what are the neoplasms which cause red lesions?

A

SCC

Amelanotic melanoma

Karposis sarcoma

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22
Q

Why do white patches look white?

A

usually due to a thickened keratin layer

23
Q

Label this layers of epithelium?

A
24
Q

what does this show?

A

hyper keratosis

25
Q

what are the main causes of white lesions? (COIN)

A

Congenital

Others- Friction/burn

infective/inflammatory

Neoplastic

26
Q

infective causes fo white lesions?

A

Candida

Hairy leukoplakia

Syphylitic patch

27
Q

Non infective causes of white lesions

A

lichen planus

Lupus erythematosis

28
Q

what is this?

A

hairy leaukoplakia (lateral borders of tongue)

29
Q

what are the congenital causes of white lesions?

A

WHITE SPONGE NAEVUS

FORDYCE spots

DYSKERATOSIS CONGENITA

LEUKOEDEMA

30
Q

Other causes of white spot lesions?

A

burns

scars

skin graft

cheek biting

31
Q

what is this?

A

frictional keratosis

32
Q

what causes intraoral pigmentation?

A

the pigmentation depends on the number of malanocytes at the basal layer or the amount of melanin produced by these melanocytes

33
Q

what is this?

A

normal melanocyte ( note it s at the basal layer)

34
Q

how can pigmentation arise?

A

Due to a pigmented foreign body

more melanocytes

more melanin produced by same number of melanocytes

35
Q

what are the sources of external pigment?

A

Amalgam tatoo

heavy metal exposure

intentional tatoo

36
Q

pigmentation secondary to a stimulus?

A

smoking

drugs

37
Q

internal causes of pigmentation?

A

Oral melanotic macule (ephelis)

Racial pigmentation

Addisson’s Disease

ACTH producing tumours

Physiologic pigmentation of pregnancy (melasma)

Peutz Jegher’s Syndrome

Post inflammatory melanin incontinence

38
Q

what do these images show?

A

amalgam tatoo

39
Q

how does physiological pigmentation occur?

A

Due to an increase in melanin produced by melanocytes.

40
Q

what can cause the melanocytes to increase melanin production?

A

long lasting inflammation such as lichen planus, pemphigus and pemphigoid.

41
Q

what does this show?

A

More pigment but the same amount of melanocytes

42
Q

what is this?

A

oral melanotic macule.

idiopathic in origin and the equivalent to a freckle.

no malignancy transformation risk.

43
Q

what is racial pigmentation?

A

Pigmented mucosa is common in those with black skin.

44
Q

what does this show?

A

increased number and nest of melanocytes

it is a neavus.

45
Q

what happens to the melancytes in oral melanoma?

A

Proliferation of malignant melanocytes along the junction between the epithelial and connective tissues & within the connective tissue

It is a rare cancer though

46
Q

Showing a malignant melanoma histology

A

increased numbers of melanocytes and malignant cytology

47
Q

How does an oral melanoma present?

A

often asymptomatic

slow growing brown or black patch

asymmetrical borders

or rapid growth, ulceration

48
Q

how do you manage oral melanoma?

A

wide excision

radiotherapy and chemotherapy often ineffective

often many metasis

Prognosis is very poor - 15% survive 5 years

49
Q

what is Primary adrenal insufficiency (addisons)

A

• Autoimmune destruction

  • TB
  • Malignancy
  • Iatrogenic
  • Destruction of the adrenal gland–>Decreased mineralo & gluco- corticoid levels

Primary adrenal insufficiency is characterized by mineralocorticoid deficiency and by hyperpigmentation

The most common causes (80%) is autoimmune adrenalitis

50
Q

what does this show?

A

Hyper pigmentation in addisons

51
Q

what would the investigations reveal in addisons?

A

elevated plasma ACTH

synacthen test

low serum sodium, and raised serum potassium

adreno-cortical antibodies - often present in autoimmune adrenalitis

abdominal film - calcified adrenals of tuberculosis

chest radiology - tuberculous lesions

52
Q

what is Peutz Jegher’s Syndrome?

A

Genetically inherited syndrome

Perioral pigmentation - multiple freckles

Intraoral pigmentation-

pigmentation may fade after puberty. Clinical diagnosis is important as there is a genetic risk of bowel cancer

53
Q

localised causes of pigmentation?

A
54
Q

what are the generalised causes of pigmentation?

A

Contraceptive pill, Antimalarials

Hypoadrenalism, increased ACTH

Drugs, smoking

Post inflammatory

Genetic–>Racial ot Peutz Jeghers

Oral med (18 decks)

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