Oral Cancer 2

Question 1

What causes a white patch?

Answer 1

Thickened epithelium + moisture = white patch
Thickened epithelium take in a lot of water and hence appear white

Question 2

Differential Diagnoses of white patches

Answer 2

• Frictional Keratosis (occlusal line on buccal mucosa)
• Lichen Planus (reticular pattern)
• Chronic hyperplastic candidiasis (commisure and inside of buccal mucosa)
• Idiopathic (eg. geographic tongue)
• Smokers keratosis (heat of cigarette smoke causes chronic thermal injury which thickens mucosa usually around roof of the mouth)
• Acute pseudomembranous candidiasis (pt who might be ill may develop acute thrush, can be wiped off with a swab)
• Oral leukoplakia (clinical diagnosis, implies it is a white patch with no other cause so it has an increased risk that it is caused by dysplasia)
• Abnormalities like dysplasia (can only be diagnosed by a biopsy as it is a histological diagnosis not a clinical diagnosis)

Question 3

What should you do if you see a white patch?

Answer 3

If there is an uncertain diagnosis, refer for a specialist opinion and consider a biopsy

Question 4

What is the RO of pts with high grade dysplasia developing oral cancer?

Answer 4

50% RO of developing oral cancer within 4 years

Question 5

What are the problems within diagnosing?

Answer 5

• It is difficult to tell benign disease from OPM - oral pre-malignant lesions (like dysplasia) / early cancer
• Oral cancer is relatively uncommon
• OPMs are much more common but benign white patches are even more common

Early diagnosis is key to good outcomes