Exam 3-Leukoplakia & Erythroplakia

Question 1

What is a clinicaly descriptive term for a white patch or plaque that won’t rub off and which can’t be diagnosed as any specific condition

Answer 1

leukoplakia

Question 2

Whats the term for REVERSIBLE hyperkeratosis from a physical irritant? *It is NOT a cause of leukoplakia!! * NOT pre-malignant

Answer 2

Frictional Keratosis

Question 3

What is the MAJORITY of leukoplakia caused by?

Answer 3

TOBACCO

Question 4

What is the name for WHITE coloration on the PALATE of a smoker with small red macules? IS it pre-malignant? WHAT are the small red macules from?

Answer 4

STOMATITIS NICOTINA…..NOT pre-malignant…red from inflamed ducts

Question 5

Histologically, 80% of leukoplakia can be described as one of these three….

Answer 5

1.hyperPARAkeratosis 2.hyperORTHOkeratosis 3.A-canth-osis

Question 6

Histo: what is an increased amount of “more nucleated” keratinized cells on the surface of the epithelium?

Answer 6

hyperPARAkeratosis

Question 7

Histo: what is an increased amount of “more mature/non nucleated” keratinized cells on the surface of the epithelium?

Answer 7

hyperORTHOkeratosis

Question 8

Histo: what is the term for an increase in thickness of epithelium?

Answer 8

A-Canth-osis (latin-thorny evergreen tree lol)

Question 9

ummm how much of leukoplakia will display as hyperparakaratosis/hyperorthokeratosis/acanthosis again??

Answer 9

80%

Question 10

What % of histologic samples of leukoplakia will show EPITHELIAL DYSPLASIA (carcinoma in situ)?

Answer 10

17%

Question 11

What % of histologic samples of leukoplakia will show superficially INVASIVE squamous cell carcinoma?

Answer 11

3%

Question 12

What is the process the epithelium goes through prior to becoming malignant?

Answer 12

epithelial dysplasia (carcinoma in situ)

Question 13

WHAT IS THE HISTOLOGIAL HALLMARK of epithelial dysplasia?

Answer 13

PleoMorphism (cells have many different shapes)

Question 14

Besides the hallmark of epithelial dysplasia in a histo sample, please name 3 other important markers…

Answer 14

1. increased/abnormal mitosis 2. increased nuclear/cytoplasmic ratios 3.hyperChromatism

Question 15

Interesting….A single incisional biopsy of leukoplakia will underdiagnose ___% of the time

Answer 15

30%

Question 16

Interesting….if we take 2 biopsies from a leukoplakia lesion our % missed diagnosis goes to ___%

Answer 16

12%

Question 17

Interesting….if we take 3 biopsies from a leukoplakia lesion our % missed diagnosis goes to ___%

Answer 17

2.4%

Question 18

What are the three areas of the oral cavity most at risk for leukoplakia? What are the % chance of dysplasia/invasion of each location?

Answer 18

1.Floor of Mouth/VENTRAL TONGUE (Freggin 50%) 2.Lateral border of the tongue (25%) 3.Lower Lip (actinic keratosis) (35%)

Question 19

What is the term for when the vermilion becomes atrophic and blends with skin, variably white ± erosion ± crusting?

Answer 19

Actinic Keratosis (or leukoplakia of the lower lip)

Question 20

NON-homogenous leukoplakia is __-__% dysplastic/invasive

Answer 20

50-80%

Question 21

Areas of redness, ulceration, pebbly or verrucous surface describe a leukoplakia lesion that is defined as:

Answer 21

NON-homogeneous

Question 22

What is the RARE form of PROGRESSIVE leukoplakia that is characterized by progression, multifocality, verrucous morphology, RECURRENCE after excision, progression to SCC and DEATH??

Answer 22

PVL-Proliferative Verrucous Leukoplakia

Question 23

OVERALL: What % of leukoplakia has a chance for malignant transformation???

Answer 23

4-6%

Question 24

OVERALL: What % of leukoplakia will transform to malignancy if DYSPLASTIC?

Answer 24

15%

Question 25

What % of leukoplakia will transform to malignancy if NOT dysplastic?

Answer 25

1-3.5%

Question 26

What is the recurrence rate for someone who has overcome oral cancer?

Answer 26

10-40%

Question 27

Hmm...what is a red patch which can't be diagnosed as a specific condition....Its a clinically descriptive term considerably LESS common than leukoplakia

Answer 27

erythroplakia

Question 28

Where is erythroplakia most likely to show up in the oral cavity?

Answer 28

the high risk sites (1.FOM/VenTongue 2.LatTongue 3.LowerLip)

Question 29

Histologically, what % of erythroplakia shows dysplasia/carcinoma in situ?

Answer 29

100% of the time...HOLY SHIT

Question 30

Most early ASYMPTOMATIC oral carcinomas are ____ or ____ AND ______ lesions.

Answer 30

red or red AND white

Question 31

How do you treat a non-dysplastic erythroplakia lesion? (like 0% of the time)

Answer 31

modify the risk factors and watch it (happens like 0% of the time)

Question 32

If an erythroplakia lesion is considered have mild to moderate dysplasia, what is the treatment?

Answer 32

modify the risk factors and MAYBE or MAYBE NOT excise it

Question 33

If an erythroplakia lesion is considered have severe dysplasia, what is the treatment?

Answer 33

modify the risk factors AND EXCISE

Question 34

When we say tx for erythroplakia is modifying the risk factors....how much of it is resolved with SMOKING tobacco cessation?

Answer 34

50% of the time its resolved

Question 35

When we say tx for erythroplakia is modifying the risk factors....how much of it is resolved with SPIT/TOPICAL tobacco cessation?

Answer 35

95% of the time the lesion is resolved!

Question 36

He powered thru this in the lecture, not sure how important it is...premalignant conditions:

Answer 36

A. SIDE-RO-PENIC dysphasia B. subMucous Fibrosis C. LICHEN PLANUS (most likely NOT pre-malignant) D. Immunosupression

Question 37

Which "pre-malignant" condition is CONTROVERSIAL because the risk is debatable....many cases represent MISDIAGNOSED cases of dysplasia

Answer 37

Lichen Planus

Question 38

What are the 4 types of epithelium?

Answer 38

Squamous, cuboidal, pseudostratified, columnar

Question 39

Which contains nuclei: ortho or parakeratin

Answer 39

parakaratin (ortho no nuclei)

Question 40

white plaque that cannot be wiped off and cannot be characterized clinically as any other disease

Answer 40

Leukoplakia