OMIT - Malignancies Flashcards
(41 cards)
What is an oral potentially malignant disorder?
A group of lesions and conditions in the oral mucosa that can display an increased risk of malignant transformation.
Most common types of OPMDs?
Leukoplakia
Erythroplakia
Oral submucous fibrosis
Oral leukoplakia clinical features?
A keratotic lesion that cannot be removed
Asymptomatic
Homogenous or non-homogenous
Oral leukoplakia risk factors
Smoking
Alcohol
Oral leukoplakia cancer risk?
anywhere from 0.13%-34%
Oral sub mucous fibrosis, define, and give clinical features.
An oral precancerous condition characterized by a inflammation and progressive fibrosis of the submucosal tissues.
Burning sensation
Blanching
Trismus
Loss of pigmentation
Mucosal surfaces and third of esophagus
key diagnostic for leukoplakia
Can’t be removed
Absence of any other cause
Diagnosis through exclusion
Leukoplakia likelyhood for malignancy
Very variable: 0.1-30%
Dependant on modifiable risk factors
Erythroplakia diagnosis
Exclusive diagnosis
Erythroplakia malignancy rate
14-15%
Define proliferative verrucous leukoplakia?
It is an aggressive slow growing form of leukoplakia with high malignant transformation.
Non-homogenous affecting multiple sites with nodular appearance. More common in females and elderly.
Histopath factors associated with risk of malignancy
Chromosome number abnormality
Loss of heterozygosity
DNA and mRNA hypermethylation
Gene expression profiling
What clinical factors raise your suspicion of malignancy?
Non-healing
Unexplained
Changes in the lesion
High risk site (ventro-lateral tongue FOM)
What is key when biopsying mixed colored lesions?
Obtain representative sample, with a sample of healthy tissue for comparison.
What screening tools are available for potentially malignant disorders?
Clinical exam under white light
Vital staining
Light based detection
Oral brush biopsy
Salivary diagnostics
What vital staining may indicate potentially malignant tissue?
Toluidine blue
Acetic acid
Lugol’s iodine solution
What are the benefits and drawbacks of vital staining?
Positives
- Further testing to confirm
- Quick results
Negatives
- Tastes bad
- False negatives
What types of light-based detection are available
Reflective visualization
Optical fluorescence imaging
What is oral brush biopsy?
Minimally invasive approach for harvesting cells in oral mucosa.
Brush obtains superficial cells, however this is less effective than full biopsy.
Utilizes exfoliative replacement cytology.
What is the purpose of salivary diagnostic as an OPMD screening tool?
Contains hormones, DNA, RNA, antibodies etc.
Saliva can mirror physiological changes of the body.
What is the difference in surgical excision margins between OPMDs and OSSC?
OSSC generally larger.
What are the main principles in treating OPMDs?
Risk factor modification
Topical medicaments
Systemic medications
Monitoring and surveillance
Surgical intervention
What types of surgical interventions can be undertaken to manage these lesions?
Excision with cold steel
Ablation
Cold blade
CO2 Laser
Photodynamic therapy
What is the purpose of prescribing steroids for OPMDs?
Symptom management only, will not lower malignancy risk.