ORAL PATH white lesions

Question 1

what type of white lesion is a fordyce granule?

Answer 1

developmental - ectopic sebaceous glands

Question 2

where do you commonly find fordyce granules?

Answer 2

lip and buccal mucosa

Question 3

what is a risk factor for fordyce granules?

Answer 3

age

Question 4

what type of white lesion is leukoedema?

Answer 4

normal variation - milky white colouration

Question 5

what type of white lesions are white sponge naevus, pachyonychia congenita, and dyskeratosis congenita?

Answer 5

hereditary

Question 6

what type of trauma can cause white lesions?

Answer 6

mechanical/ frictional
chemical
thermal

Question 7

what type of white lesions are lichen plans and lupus erythematosus?

Answer 7

dermatological

Question 8

what type of white lesions are candidosis, syphilitic leukoplakia, and oral hairy leukoplakia?

Answer 8

infective

Question 9

what type of white lesions are leukoplakia and proliferative verrucous leukoplakia?

Answer 9

idiopathic

Question 10

what type of white lesions are dysplastic lesions and SCCs?

Answer 10

neoplastic

Question 11

describe white sponge naevus

Answer 11

ill-defined white patched with ‘shaggy’ surface
often bilateral

Question 12

what areas can white sponge naevus affect?

Answer 12

any part of oral mucosa esp buccal mucosa
can also affect nose, oesophagus, and anogenital region

Question 13

what causes white sponge naevus?

Answer 13

mutations in keratins 4 or 13

Question 14

what is the treatment for white sponge naevus?

Answer 14

none required just explanation

Question 15

what are the clinical features of oral hairy leukoplakia?

Answer 15

white, shaggy appearance on lateral tongue
asymptomatic
can affect other sites too

Question 16

what is the cause of oral hairy leukoplakia?

Answer 16

EBV infection

also strongly associated with HIV infection

seen in immunocompromised and healthy pts

Question 17

what is the treatment for oral hairy leukoplakia?

Answer 17

no treatment

Question 18

describe frictional keratosis?

Answer 18

roughened white patch at site of chronic trauma

• hyperkeratosis
• prominent scarring fibrosis within submucosa

Question 19

what is the treatment for frictional keratosis?

Answer 19

should resolve when source of friction is removed

Question 20

what is lichen planus?

Answer 20

common chronic inflammatory disease of the skin and mucous membranes

Question 21

what does lichen planus present with?

Answer 21

oral lesions in 50% of pts with skin lesions
buccal mucosa is most common site

Question 22

describe LP skin lesions

Answer 22

violaceous itchy papule which may have distinctive white streaks on the surface (Wickham’s striae)

Question 23

where is the most common site for LP skin lesions?

Answer 23

flexor surface of wrist

Question 24

how long do LP lesions last?

Answer 24

skin lesions develop slowly and 85% resolve within 18 months

oral lesions run chronic course, sometimes several years.

Question 25

describe LP oral lesions

Answer 25

spectrum of appearances usually bilateral and often symmetrical

Question 26

what is the aetiology of lichen planus?

Answer 26

unknown chronic inflammatory disease of the skin and mucous membranes

Question 27

what are the 6 difference appearances of LP?

Answer 27

reticular atrophic plaque-like papular erosive bullous

Question 28

describe reticular LP?

Answer 28

most common lace-like striae

Question 29

describe strophic LP

Answer 29

diffuse red lesions resembling erythroplakia

Question 30

describe plaque-like LP

Answer 30

white plaques resembling leukoplakia

Question 31

describe papular LP

Answer 31

small white papules which may coalesce

Question 32

describe erosive LP

Answer 32

extensive areas of shallow ulceration

Question 33

describe bullous LP

Answer 33

subepithelial bullae

Question 34

why are clinical findings very important when you think you see LP?

Answer 34

the histopathology of lichenoid reaction is similar to lichen planus

Question 35

what are LP histopathological features also seen in?

Answer 35

lichenoid reaction to drugs/ restorative materials lupus erythematosus graft vs host disease lichenoid inflammation associated with dysplasia

Question 36

what is treatment for lichen planus ?

Answer 36

if symptomatic, options include steroids

Question 37

is lichen planus an oral potentially malignant disorder?

Answer 37

possible frequency of malignant change in LP is controversial but likely low

Question 38

what is leukoplakia?

Answer 38

a clinical term used to describe a white plaque of questionable risk after having excluded other known diseases

Question 39

is leukoplakia an OPMD?

Answer 39

risk of malignant transformation is low

Question 40

what is proliferative verrucous leukoplakia?

Answer 40

a clinical pathological variant of oral leukoplakia it is multifocal, persistent and progressive with a high rate of recurrence, and a high risk of progression to squamous cell carcinoma

Question 41

what are risk factors of proliferative verrucous leukoplakia?

Answer 41

older pts F>M

Question 42

where would you find PVL?

Answer 42

gingiva alveolar ridge buccal mucosa tongue hard palate

Question 43

if PVL turns into cancer, what is it called?

Answer 43

verrucous carcinoma or squamous cell carcinoma

Question 44

what is the key histological feature of lichenoid inflammation/ lichen planus?

Answer 44

civatte bodies

Question 45

what must you warn the patient when diagnosing lichen planus?

Answer 45

it is potentially malignant