Chapter 10: Epithelial Pathology PART 2 Flashcards
1
Q
___ is an oral counterpart to ephelis
A
oral melanotic macule
2
Q
___ is a brown asymptomatic macule produced by a focal increase in melanin deposition
A
oral melanotic macule
3
Q
are oral melanotic macules dependent on sun exposure?
A
no
4
Q
what is the most common site of oral melanotic macules?
A
vermillion zone of the lower lip (labial melanotic macule)
5
Q
___% of oral melanotic macules are solitary
A
80%
6
Q
there is no malignant transformation potential of oral melanotic macule, but it is clinically indistinguishable from what?
A
early melanoma
a biopsy is mandatory
7
Q
___ is an acquired pigmentation of the oral mucosa that appears to be a reactive process due to trauma
A
oral melanoacanthoma
8
Q
oral melanoacanthoma is characterized by ___ throughout the epithelium
A
dendritic melanocytes
9
Q
A
oral melanotic macule
10
Q
A
labial melanotic macule
11
Q
is oral melanoacanthoma related to melancanthoma of the skin?
A
no
12
Q
oral melanoacanthoma is seen almost exclusively in what population, and is it more common in males or females?
A
african americans
F>M
13
Q
oral melanoacanthoma is most common in what age?
A
20-30s
14
Q
what is the most common site of oral melanoacanthoma occurrence?
A
buccal mucosa
15
Q
oral melanoacanthoma is typically asymptomatic, but can cause ___ and ___
A
pain and burning
16
Q
how does oral melanoacanthoma clinically appear?
A
smooth, dark brown macule
lesions increase rapidly in size
17
Q
incisional biopsy is indicated in cases of oral melanoacanthoma to rule out ___
A
melanoma
18
Q
what is the treatment for oral melanoacanthoma? is there a risk of malignant transformation
A
- biopsy to rule out melanoma
- no further treatment - lesions regress after incisional biopsy
- is there a risk of malignant transformation?
19
Q
bottom photo is after biopsy
A
oral melanoacanthoma
20
Q
___ is the most commonly recognized nevus
A
acquired melanocytic nevus
aka mole
21
Q
___ is a benign, localized proliferation of cells from the neural crest, and is the most common of all adult tumors
A
acquired melanocytic nevus
22
Q
white adults can have how many acquired melanocytic nevus lesions? where are most lesions present?
A
- 10-40
- above the waist
23
Q
what are the 3 clinical stages of acquired melanocytic nevus?
A
- junctional
- compound
- intradermal
24
Q
which stage of acquired melanocytic nevus is the earliest presentation and appears as a dark macule less than 6mm?
A
junctional
25
which stage of acquired melanocytic nevus occurs as the nevus cells proliferate and the lesion becomes a slightly elevated, soft papule with a smooth surface; the degree of pigmentation decreases
compound
26
which stage of acquired melanocytic nevus is characterized by the lesion surface becoming somewhat papillomatous; hairs grown from the center; loses most or all of its pigmentation? what is the name give to it if it is in the oral cavity?
* intradermal
* intramucosal if it is in the oral cavity
27
are intraoral melanocytic nevi common? what is the fraction that are found in females?
* uncommon
* 2/3 are found in females
28
most intraoral melanocytic nevi have an evolution and appearance similar to \_\_\_, and have a predilection for the \_\_\_
* skin nevi
* palate
29
what is the treatment for acquired melanocytic nevi? what is the risk of transformation?
* no treatment necessary unless there is clinical change or found in the oral cavity
* most will regress
* risk of transformation of an acquired melanocytic nevus is one in a million
30
acquired melanocytic nevus
31
acquired melanocytic nevus
32
acquired intraoral melanocytic nevus
33
acquired intraoral melanocytic nevus
34
congenital melanocytic nevi affect \_\_\_% of newborns
1%
35
congenital melanocytic nevi are divided into what two categories?
small (less than 20cm) and large (greater than 20cm)
36
small type congenital melanocytic nevi are similar in appearance to \_\_\_, except they are usually larger
acquired melanocytic nevi
37
describe large type congenital melanocytic nevi
* plaques with a rough or nodular surface and often change with time
* common feature is hypertrichosis (excess)
38
a very large congenital nevus can be called a ___ or \_\_\_
bathing trunk or garment nevus
39
up to \_\_\_% of large congenital nevi may undergo malignant transformation into melanoma. what should you do with these lesions?
* 15%
* these lesions should be removed entirely if feasible; otherwise, close follow-up is required
40
a ___ is a melanocytic nevus with a surrounding pale hypopigmented border
halo nevus
41
halo nevi are thought to result from what?
nevus cell destruction by the immune system
42
congenital melanocytic nevus
large type (characteristic hypertrichosis)
43
halo nevus
44
\_\_\_ is an uncommon, benign proliferation of dermal (or intramucosal) melanocytes that comes in two forms: common and cellular
blue nevus
45
what is the blue color of blue nevi due to?
* tyndall effect - melanin particles are deep to the surface, so the light reflected back must pass through overlying tissues
* colors with long wavelenths (red/yellow) are more easily absorbed by the tissues
* blue has a shorter wavelength and is reflected
46
how are blue nevi treated? what is the risk of malignant transformation?
* conservative surgical excision with minimal chance of recurrence
* oral lesions must be biopsied to rule out melanoma
* malignant transformation has been reported but is very rare
47
intraoral blue nevus
48
blue nevus
49
\_\_\_ is an intraoral white plaque that does not rub off and cannot be identified as any well known entity
leukoplakia
* if it can be rubbed off, it is not leukoplakia
* if it is easily recognizable as a well known entity, it is not leukoplakia
50
why are leukoplakia lesions white?
because there is something (keratin, microbial colony, scar tissue, necrosis, etc.) that is blocking the "redness" of the underlying vascular tissue
51
what are some examples of white lesions that can be scraped off?
* materia alba
* white coated tongue
* burn (thermal, chemical, cotton roll, etc)
* pseudomembranous candidiasis
* sloughing from toothpaste
52
leukoplakia is considered a ___ lesion
premalignant
53
leukoplakia comprises \_\_\_% of oral precancer
85%
54
\_\_\_ or ___ is seen in 20% of biopsy samples of clinical leukoplakia
dysplastic epithelium or squamous cell carcinoma
55
80% of leukoplakia biopsies are \_\_\_
benign hyperkeratosis
56
what is the malignant transformation potential of leukoplakia?
5-50%, depending on the clinical subtype
57
leukoplakia has a strong ___ predilection
male
58
what are the 6 etiologies of leukoplakia?
* tobacco
* smoking
* sanguinaria
* UV radiation
* microorganisms
* trauma
59
describe leukoplakia with a tobacco etiology
* 80% of patients with leukoplakia smoke
* smokeless tobacco = tobacco pouch keratosis
60
leukoplakia with an alcohol etiology has a synergistic effect with \_\_\_
tobacco
61
describe leukoplakia with a sanguinaria etiology
* an herbal extract found in toothpaste or mouth rinses
* leukoplakia occurs in the maxillary vestibule or alveolar mucosa of the maxilla
* 80% of patients with leukoplakic lesions here have a history of using sanguinaria products
62
leukoplakia with a UV radiation etiology causes leukoplakia in what location?
lower lip vermillion
63
describe leukoplakia with a microorganism etiology
* treponema pallidum (glossitis in 3rd stage syphilis)
* candida albicans can colonize the superficial oral mucosa to produce a thick plaque (candidal hyperplasia)
* HPV 16 and 18 has been identified in some leukoplakias
64
describe leukoplakia with a trauma etiology
* not precancerous
* not true leukoplakia
* exmamples: nicotine stomatitis and frictional keratosis
65
the prevalence of leukoplakia increases rapidly with \_\_\_
age
66
70% of leukoplakia lesions are found where?
lip vermillion, buccal mucosa, gingiva
67
90% of leukoplakias with dysplasia or carcinoma are found where?
lip vermillion, lateral/ventral tongue, floor of mouth
68
lesions that demonstrate scattered red patches are termed \_\_\_
erythroplakia
69
erythroplakia found in areas of leukoplakia represents site in which ___ cells are so immature they can no longer produce \_\_\_
* epithelial
* keratin
70
red (erythroplakia) and white (leukoplakia) intermixed lesions are termed ___ or \_\_\_
erythropeukoplakia or speckled leukoplakia
71
erythroplakia and erythroleukoplakia frequently reveal advanced ___ on biopsy
dysplasia
72
\_\_\_ is a special high-risk form of leukoplakia characterized by multiple keratotic plaques with roughened surface projections
proliferative verrucous leukoplakia (PVL)
73
proliferative verrucous leukoplakia lesions spread slowly throughout the \_\_\_, and as the lesion progresses, ___ can develop
* mouth
* carcinoma
74
is PVL difficult to treat? do lesions recur?
it is difficult to treat, and lesions will recur
75
why is PVL unusual?
there is a 4:1 F:M predilection and no association with tobacco use
76
the histoplathology of leukoplakia includes what 4 things?
* hyperkeratosis - thickened keratin layer
* hyperparakeratosis - no granular cell layer; nuclei are retained
* hyperorthokeratosis - granular cell layer; nuclei are lost
* acanthosis - thickened spinous layer
77
when there is concern about malignancy with leukoplakia, ___ techniques such as cytologic testing (including brush biopsy) and lesion staining with supravital dyes should not be considered as substitutes for \_\_\_
* noninvasive screening
* biopsy
78
the first step in treating leukoplakia is arriving at a \_\_\_. therefore, ___ is mandatory
* definitive diagnosis
* biopsy
* taken from most severe looking areas of involvement
79
describe the alterations found in leukoplakia biopsies that are consistent with mild dysplasia, moderate dysplasia, severe dysplasia, and carcinoma in situ
* mild dysplasia - alterations are limited to the lower 1/3
* moderate dysplasia - alterations are limited to the lower 1/2
* severe dysplasia - alterations are present above the lower 1/2
* carcinoma in situ - alterations are present throughout epithelium
80
management of leukoplakia with mild dysplasia is guided by what?
the size of the lesion and the response to more conservative measures (aka smoking cessation)
81
management of leukoplakia with moderate epithelial dysplasia or worse warrants what?
complete removal or tissue
82
why is long-term follow up after leukoplakia treatment important?
* recurrences are frequent (85% in verruciform)
* additional leukoplakias may develop
* overall, 5% of leukoplakias become squamous cell carcinoma, usually within 2-4 years
83
what are 4 factors that increase the risk for cancer in leukoplakias?
* persistence over several years
* female patient
* nonsmoker
* oral floor or ventral tongue lesions
84
\_\_\_ is defined as a red patch that cannot be diagnosed as any other condition
erythroplakia
85
T or F:
true erythroplakias are benign
false
true erythroplakias are never completely benign
86
90% of erythroplakias show ___ on biopsy
moderate dysplasia or worse
87
what are the causes of erythroplakia?
unknown, but they are assumed to be the same as invasive squamous cell carcinoma
88
erythroplakia predominantly occurs in what age patient, and with what gender predilection?
* middle-aged to older adults (average = 70yo)
* no gender predilection
89
what are the most common locations of erythroplakia?
* floor of mouth
* ventral tongue
* soft palate
90
what does the altered mucosa look like in erythroplakia?
well-demarcated macule or plaque with a soft, velvety texture
91
is erythroplakia typically symptomatic or asymptomatic?
asymptomatic
92
erythroplakias are red in color due to what?
* lack of keratin and epithelial thinness
* allows underlying vasculature to show
93
\_\_\_ is mandatory for erythroplakia, and treatment is guided by \_\_\_
* biopsy
* definitive diagnosis
94
describe recurrence and multifocal oral involvement of erythroplakia
both are common, therefore long-term follow up is required
95
proliferative verrucous leukoplakia
96
proliferative verrucous leukoplakia
97
erythroleukoplakia
98
does not rub off
leukoplakia
99
erythroplakia
100
erythroplakia
101
what are the 3 types of smokeless tobacco, and what population most commonly uses each?
* chewing tobacco - men during outdoor activities
* moist snuff - most popular
* dry snuff - southern women
102
what is the most common local change seen in patients using smokeless tobacco?
* characteristic, painless loss of gingival tissues in area of tobacco contact
* gingival recession may be accompanied by destruction of facial surface of alveolar bone; correlates with quantity of daily use and duration of habit
103
a ___ stain on the teeth is common in patients using smokeless tobacco
brown-black extrinsic tobacco stain
104
halitosis is a frequent finding of patients using \_\_\_
smokeless tobacco
105
what is smokeless tobacco keratosis?
a characteristic white plaque that is produced on the mucosa in direct contact with smokeless tobacco
106
do smokeless tobacco keratosis lesions develop shortly after tobacco use or after a long history of use?
shortly after heavy tobacco use begins; new lesions seldom arise in people with a long history of tobacco use
107
what do smokeless tobacco keratosis lesions look like clinically?
thin, gray or white plaque with a border that blends into the surrounding mucosa; appears fissured or rippled
108
do smokeless tobacco keratosis lesions exhibit induration, ulceration, pain, or epithelial dysplasia?
* NO induration, ulceration, or pain
* epithelial dysplasia is uncommon, but if it is present, it is mild
109
when is a biopsy warranted in smokeless tobacco keratosis lesions?
only for more severe lesions or for a lesion remaining 6 weeks after habit is stopped
110
what is the treatment for smokeless tobacco keratosis?
* altnerate the site of tobacco placement
* habit cessation leads to normal mucosal appearance in 98% of users, usually in 2 weeks
111
gingival recession due to smokeless tobacco
112
smokeless tobacco keratosis
113
smokeless tobacco keratosis
114
smokeless tobacco keratosis
