Epithelial Neoplasms

Question 1

Multifactorial disease
– Two distinct pathogenesis models:
• Smoking and alcohol
• Human papilloma virus (HPV 16 & 18)
– Actinic Radiation: Lip cancer

Answer 1

H+N SCC

Question 2

What are the 4 most common etiological factors of oropharyngeal squamous cell carcinoma?

Answer 2

Smoking
Alcohol
Actinic radiation
HPV

Question 3

What age group and category of person is at the highest risk for a H+N SCC?

Answer 3

White male 65+ smoker and drinker

Question 4

• Areca nut
• Betel leaf
• Lime
•CaOH2
• Nitrosamines
Causes oral submucous fibrosis

Answer 4

Betel Quid

Question 5

• 44M with 22 year history of use of 
betel nut-containing preparations
• Limited oral opening, fibrous bands 
and leukoplakia with erosions
• Premalignant condition

Answer 5

Oral submucous fibrosis

Question 6

What is the cause of acinitic damage?

Answer 6

UV light

Question 7

• The larger the tumor the ______ the

incidence of metastasis

Answer 7

higher

Question 8

The occurrence of metastasis

______ survival

Answer 8

decreases

Question 9

SCC clinical appearance:

– Mass-forming
– Fungating
– Papillary
– Verruciform

Answer 9

• Exophytic

Question 10

SCC clinical appearance:

– Invasive
– Indurated
– Ulcerated

Answer 10

• Endophytic

Question 11

White plaque

Answer 11

• Leukoplakia:

Question 12

Red plaque

Answer 12

• Erythroplakia:

Question 13

Red & white plaque

Answer 13

• Erythroleukoplakia:

Question 14

• A white patch or plaque that can’t be characterized clinically or
pathologically as any other disease

Answer 14

Leukoplakia

Question 15

Things making lesions white:

Increased opacity

Answer 15

Hyperkeratosis:

Question 16

Things making lesions white:

Increased thickness

Answer 16

Acanthosis:

Question 17

Things making lesions white:
Fibrin membrane or
fungal hyphae

Answer 17

Surface coating:

Question 18

The following are or are not leukoplakia
• Morsicatio buccarum
• Linea alba

Answer 18

Not leukoplakia

Question 19

What percentage of leukoplakias are dysplastic/premalignant?

Answer 19

20%

Question 20

• A red plaque that can’t be characterized clinically or pathologically as any
other disease

Answer 20

Erythroplakia

Question 21

What are the 2 reasons why erthroplakias are red?

Answer 21

Thin epithelium

Red blood cells

Question 22

What percentage of erythroplakia are dysplastic or malignant?

Answer 22

90%

Question 23

What are the 5 High Risk Areas for Premalignancy and Malignancy?

Answer 23

• Lower Lip
• Floor of Mouth
• Ventral Tongue
• Lateral Border of Tongue
• Soft Palate

Question 24

____ or _____ is required for definitive diagnosis of oral SCC

Answer 24

Excisional and incisional biopsy

Question 25

``` • Low-grade variant of squamous cell carcinoma • Locally invasive, no metastasis • Cytologically bland • Clinicopathologic correlation • Associated with smokeless tobacco ```

Answer 25

Verrucous Carcinoma

Question 26

* High-risk, aggressive type of oral leukoplakia * High potential for malignant transformation * Not associated with tobacco use * Women outnumber men * Slow-growing * Begins as hyperkeratosis * Spreads to become multifocal and verruciform * Resistant to therapy and recurs * Malignant transformation * Diagnosis often retrospective

Answer 26

Proliferative Verrucous Leukoplakia

Question 27

What is the most common skin cancer that rarely metastasizes?

Answer 27

Basal cell carcinoma

Question 28

What is the least common skin cancer causing the most deaths?

Answer 28

Malignant melanoma

Question 29

``` • Most common skin cancer • Sun-exposed skin of adults with fair complexions • Locally invasive • Metastasis extremely rare • Arises from basal cell layer and skin appendages ```

Answer 29

Basal cell carcinoma

Question 30

• Melanocytes present, no melanin produced in skin, hair, eyes • Enzyme defect: Tyrosinase

Answer 30

Oculocutaneous albinism

Question 31

* No melanocytes, no melanin | * Autoimmune

Answer 31

Vitiligo

Question 32

* Focal increase in melanin * Normal number of melanocytes * Lower lip vermillion most common

Answer 32

Oral Melanotic Macule

Question 33

``` • Generic term for a developmental malformation of skin or musosa • Melanocytic • Epithelial • Vascular • Basal cell • White sponge • Sebaceous ```

Answer 33

Nevus

Question 34

• A benign proliferation of nevus cells that develops during childhood and evolves through clinical stages (nevus life cycle) • Less than 6 mm

Answer 34

Acquired Melanocytic Nevi

Question 35

• Larger than acquired nevi and involve deeper structures • Large congenital nevi have higher risk for melanoma

Answer 35

Congenital Melanocytic Nevi

Question 36

• Spindled nevus cells in connective tissue

Answer 36

Blue Nevus

Question 37

``` • Malignant lesion of melanocytic origin • Acute rather than chronic sun damage • Prognosis related to depth of invasion ```

Answer 37

Melanoma

Question 38

What are the ABCDs of clinical features of Melanoma?

Answer 38

Asymmetry Border Irregularity Color Variation Diameter

Question 39

What is the diameter of a melanoma?

Answer 39

Greater than 6 mm

Question 40

What is the diameter of a melanoma?

Answer 40

Greater than 6 mm

Question 41

_____ growth phase of melanomas | – Within the epithelium (in situ)

Answer 41

• Radial Growth Phase:

Question 42

_____ growth phase of melanomas – Invasion

Answer 42

• Vertical Growth Phase

Question 43

* White adults over 50 years * Hard palate, maxillary alveolus * Amelanotic forms

Answer 43

Oral Mucosal Melanoma

Question 44

• Over 130 subtypes of double-stranded, circular DNA viruses – family of viruses that can cause abnormal tissue growth and other changes to cells – Can produce epithelial tumors of the skin and mucous membranes • Infection occurs when basal cells of the epithelium are exposed to infectious virus through a disruption in the epithelial barrier • Once the epithelial cell is infected, viral replication is confined to the nucleus • In oncogenic (high-risk) subtypes, oncoproteins E6 and E7 inactivate tumor supressor genes p53 and pRB

Answer 44

HPV

Question 45

``` • Solitary lesion in adult • Pedunculated, exophytic papule • Numerous surface projections • HPV-6, 11 ```

Answer 45

Squamous papilloma

Question 46

``` • Skin of hands in children • Multiple, clustered lesions common • White, verrucoid surface • Autoinoculation of oral mucosa ```

Answer 46

Verruca vulgaris

Question 47

``` • HPV types 13 and 32 • Children • Native Americans and other ethnic groups • No treatment, spontaneous regression ```

Answer 47

Focal Epithelial Hyperplasia (Heck’s Disease)

Question 48

``` • Venereal wart: – Sexually-transmitted disease • Multiple, clustered lesions common • Sessile, pink exophytic mass, larger than squamous papilloma • Low-risk subtypes HPV 6 and 11 ```

Answer 48

Condyloma Acuminatum

Question 49

* Most commonly found in children * Infection during childbirth * Not a sexually-transmitted disease * HPV-6 and 11 * May cause airway obstruction * Recur frequently

Answer 49

Laryngeal Papillomatosis

Question 50

__% of HPV genital infections clear on their own within 2 years

Answer 50

90%

Question 51

____% of persistent genital HPV infections will cause dysplastic changes of the uterine cervix will result in squamous cell carcinoma over a span of 7-10 years

Answer 51

5%