Oral Lesions + SSC Flashcards by O lawformonde

Aphthous Stomatitis : population

25%
Females
Congenital

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Aphthous Stomatitis : pathogenesis

UNCLEAR
Immunodeficiency
Decrease of mucosal barrier
Genetic
Antigenic exposure

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Aphthous Stomatitis :

Associated conditions

Inflammatory Bowel Disease (chrohn’s)
Celiac disease
Betchet’s Syndrome (eye, genital)
SMOKING LOWERS

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Aphthous Stomatitis:

Patho

Recurring, SUPER painful solitary/multiple ulcer

White-yellow pseudomembrane

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Aphthous Stomatitis:

Variants?

Minor
Major
Herpetiform

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Minor Aphthous Stomatitis:

Path

Well-circumscribed, superficial
<1cm
Labial / buccal mucosa, ventral tongue

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Minor Aphthous Stomatitis:

Duration

10-14 days
No scarring
1-3 episodes/year

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Major Aphthous Stomatitis:

Path

Onset after puberty
Lesions - larger,deeper, more
Tongue, soft palate, tonsillar fauces

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Major Aphthous Stomatitis:

Duration

2-6 weeks

Heals w/ scarring

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Herpetiform Aphthous Stomatitis:

Path

Onset - adulthood
Many lesions + recurrences
Small (1-3mm), coalesce
Any oral surface

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Herpetiform Aphthous Stomatitis:

Duration

7-10 days

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Aphthous Stomatitis :

history, PE

Should resolve in 2 weeks, if no, biopsy

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Aphthous Stomatitis:

SYMPTOMATIC
Corticosteroids
*Fluocinonide gel
*Clobetasol propionate gel
*Triamcinolone acetonide

Chlorhexidine Gluconate (peridex) mouthwash
Amelexanox Paste (Aphthasol)

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Aphthous Stomatitis:

pain relief

Viscous lidocaine
OTC Benzacaine (oragel, anbesol)
MOM antacid + diphenhydramine swish

Possible prednisone

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Oral Herpes Simplex :

Etiology

15-45%
Primary infection in childhood
Most common site 2ndry Infxn - vermillion border/ perioral area (herpes labialis)

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Acute Herpetic Gingiosomatitis:

Etiology

6 mos - 5 years
Peak 2-3 years old

Maternal antibodies younger than 6 mos

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Acute Herpetic Gingivostomatitis:

Presentation

Abrubt onset
Cervical lymph
High fever
Chills, nausea, anorexia
Irritability

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Acute Herpetic Gingivostomatitis:

Path

Lesion - vermillion border/lips to perioral area
Pinhead vesicles –> central ulcerations, erythema
Enlarged angry gingiva

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Acute Herpetic Gingivostomatitis:

Adult presentation

Pharyngotonsillitis
(Vesicle - tonsil, post. Pharynx)
Resolve in 1-2 weeks

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Oral Herpes Simplex:

Secondary/Recurrent Infection Triggers

UV, Trauma, Stress, Pregger

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Herpes Labialis:

Path

6-24 hour prodrome
Rupture/Crust 1-2 days
Heal 7 - 10 days

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Herpes Labialis:

History + P.E.
Viral culture
PCR
Serology - 4-8 days
Chronic? biopsy

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Tzank prep

Herpes (multinucleated epithelial)

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Varicella

Differential signs

Itching

All lesion phases

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Herpes Zoster: differential signs

Dermatome on 1 side | Older

Mononucleosis: Differential signs

posterior tonsil exudate

Hand-and-Foot (Coxsackie) differential signs

Hands and feet | Younger

Herpes simplex: Tx

``` SUPPORTIVE Viscous lidocaine NSAID Acyclovir (Zovirax) Valacyclovir (Valtrex), Famciclovir (Famvir) 1st infxn: acyc, valacy 2nd infxn: famcic, acyc Penciclovir cream ```

Oral Lichen Planus: Dx. 5 Ps

``` Purple Pleuritic Planar Papular Plaque-like ```

If have Lichen planus, you should screen for

Hep C

Oral Lichen Planus: Etiology

Women | 30-60 y/o

Oral Lichen Planus: Presentation

LESIONS - Multiple, bilateral, symmetrical LOCATION - buccal mucosa, gingiva, tongue dorsum, labial mucosa, lower vermillion Koebner Phenomenon

Oral Lichen Planus : Presentation types

Reticular - white Erythematous - Atrophic/ulcer Erosive - bullous, ulcerated

Oral Lichen Planus: Reticular lesions

Wickman's Striae | Asymptomatic

Oral lichen planus : Erythematous

Wickman's Straie | Mucosal atrophy - red patch

Oral lichen planus: Erosive

Desquamative gingivitis, frank ulcers, erosions | Bullae - easily rupture

Differential - white oral lesions

Candidiasis, leukoplakia, secondary syphilis, discoid lupus

Differential - Erythematous/Ulcerative lesions

``` Aphthous ulcers Discoid lupus Erythema multiforme Primary HSV stomatitis Oral SCC ```

Oral Lichen Planus: Dx

Hx + PE | Bilateral whitman's straie (one side- biopsy gingiva)

Oral Lichen Planus: Tx

``` No cure Oral hygiene No tobacco/alcohol 1st line - topical corticosteroid *Clobetasol proprionate *Betamethasone proprionate ```

Oral Lichen Planus : prognosis

Chronic, variable No spontaneous remission Post-inflame hyperpigmentation Possible turn to SCC (6mos monitor)

Oral Lichenoid Drug Reacions (OLDR)

``` Less common than cutaneous Adults UNILATERAL NAKS (nsaids, ACEI, Ketoconazole, Sulfonylureas) ```

Leukoplakia : Presentation

White patch, doesn't scrape Lip vermillion, buccal mucosa, gingiva Early lesions - exophitic, gray/white Homogenous/heterogeneous

Leukoplakia: cancer?

Slower transform to SCC Ventral tongue, oral floor Female, non-smoker 5-25% - epithelial dysplasia

Leukoplakia: Dx

Biopsy | Hyperkeratosis, acanthosis

Leukoplakia : Tx

No dysplasia - monitor every 6 mos. | Moderate dysplasia - excision

Proliferative Verrucous Leukoplakia

DO NOT MISS DX Female Keratotic plaques, rough surface projection 60% to SCC w/in 7 yrs

Erythroplakia: Etiology

Age 65-74

Erythroplakia: Path

Mouth floor, ventral tongue, soft palate Multiple lesions Well-demarcated, red, asymptomatic, macule/plaque, soft velvety (no keratin)

Erythroplakia : Dx

Biopsy

Erythroplakia : Tx

Guide by degree of dysplasia MODERATE - full excision Follow-up : recurrence

Oral SCC : Etiology

90% oral cancer Male, >40, AA. Tobacco use + heavy ETOH UV/radiation, phenolic, Betal, Plummer Vinson, Vit A, 3 syphilis, HPV, immune

Oral SCC: Path

Tongue, mouth floor, vermilion lip border

Oral cavity

``` Lips Buccal mucosa Front 2/3 of tongue Teeth Floor of mouth Hard palate Retro molar area ```

Oropharynx

Back 1/3 tongue Soft palate Tonsils+pillars Throat Back wall

Oral SCC warning sign

LESION 2 WEEKS + | Pain, lump, ear pain, bleeding, bad breath

Lip Vermillion Carcinoma: Etiology

Light-skin, sun

Lip Vermillion Carcinoma

``` Lower lip Crusted, nontender, oozing w/ ulcer <1cm Slow grower, late meta Submental nodes ```

Intraoral SCC : Where

Tongue - post. Lat, ventral Oral floor- from leuko/erythroplakia Gingival - bone, tobacco, female Posterior - advanced lesion

Intraoral SCC : Presentation (lesions)

Most NO PAIN Leuko/erythro/erythroleukoplakia Exophytic/endophytic Bone - moth bite, radiolucent

Intraoral SCC : Dx

Biopsy Scope 2nd cancer - larynx, lung, esophagus Head/Neck - CT Chest - CT/x-ray

Intraoral SCC : Metastases

Ipsilateral cervical node Oral floor --> submental Lung, liver, bone

Carcinoma staging TNM

T : tumor size (I, II, III, IV) N: node M: metastases

Intraoral SCC: Tx

Guided by stage | Excision, radiation, chemo/radio

Intraoral SCC : Prognosis

1/2 die w/in 5 yrs (BAD) Survive 1st cancer - 20x for next Early Dx + prevention

Oral Lesions + SSC Flashcards

(65 cards)