BDS5 oral disease > oral pigmentation > Flashcards

oral pigmentation Flashcards

(45 cards)

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1
Q

describe melanocyte histological appearance (3)

A
  • spaced dendritic cells in basal layer
  • small with clear cytoplasm
  • S100 stain
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2
Q

describe melasma (what, cause)

A
  • disorder with patchy discolouration of the skin, often of the face
  • sun exposure, genetics, hormones
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3
Q

how does physiological pigmentation present? (3)

A
  • bilateral, diffuse
  • brown (but can range)
  • often on gingiva and BM
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4
Q

describe smoker’s melanosis (5)

A
  • ~1/5 of smokers, dose dependent
  • post-inflammatory change
  • dark brown/black
  • gingiva, hard palate, BM
  • often resolves on smoking cessation
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5
Q

how does Addison’s disease affect melanin production?

A
  • primary adrenal insufficiency (cortisol/aldosterone) causing increased ACTH
  • ACTH also promotes melanogenesis
    (also mood disturbances, nausea, vomiting, weight loss)
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6
Q

describe Peutz-Jegher syndrome (what, s/s)

A
  • mutations in STK11
  • mucocutaneous pigmented macules with intestinal polyposis (small intestine, rarely undergo malignant transformation)
  • flat brown/black spots - lower lip, BM, tongue, palate +/- hands/feet
  • histologically similar to melanotic macule
  • often fade post-puberty
  • polyps may grow large - obstruct bowel, pain
  • increased risk of cancer development
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7
Q

common sites for pigmented macules of Peutz-Jegher syndrome (5)

A
  • lower lip
  • BM
  • tongue
  • palate
  • sometimes hands and feet
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8
Q

describe Laugier Hunziker syndrome (3)

A
  • similar features to Peutz-Jegher syndrome but no intestinal polyps
  • multiple acquired pigmented macules of lips and oral mucosa
  • females 2x more
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9
Q

describe LEOPARD syndrome

A
  • different types, AD RAS gene mutations
    Lentigines (pigmented macules)
    ECG abnormality
    Ocular hypertelorism
    Pulmonary stenosis
    Abnormal genitalia
    Retarded growth
    Deafness
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10
Q

describe melanotic macules (4)

A
  • well-defined, flat brown lesions
  • increase in melanin production
  • lips, gingivae, BM, palate
  • no tx needed
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11
Q

common intraoral areas for melanotic macules (4)

A
  • lips
  • gingivae
  • BM
  • palate
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12
Q

describe lentigo (what, types)

A
  • well-defined pigmented lesion of skin
  • increase in benign melanocytes with associated increase in melanin pigment
  • photo/actinic lentigo = associated with sun exposure and photodamage, older pts on face and hands
  • lentigo simplex = non-sunexposed skin, children
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13
Q

what is the common name for lentigines and ephelides?

A

freckles

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14
Q

describe naevus of Ota (3)

A
  • benign melanosis due to failed migration of melanocytes from neural crest
  • females
  • hyperpigmentation of ophthalmic and maxillary branches of CV (white of eye, face)
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15
Q

describe naevus of Ito (3)

A
  • benign melanosis due to failed migration of melanocytes from neural crest
  • females
  • hyperpigmentation affecting posterior supraclavicular and lateral brachial cutaneous nerves
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16
Q

what is the difference between naevus of Ota vs naevus of Ito?

A

hyperpigmentation affecting:
- CV1, CV2 = Ota
- posterior supraclavicular and lateral brachial = Ito

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17
Q

what is the common name for melanocytic naevi?

A

moles

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18
Q

describe melanocytic naevi (what, where, appearance)

A
  • benign neoplasm of melanocytes
  • mostly acquired
  • skin or intraoral - hard palate, buccal mucosa, gingiva
  • well-circumscribed, dark with smooth or cerebriform surface
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19
Q

common intraoral sites of melanocytic naevi (3)

Study These Flashcards
A
  • hard palate
  • BM
  • gingivae
20
Q

what are the 3 phases of melanocytic naevi and how do their clinical appearances differ?

Study These Flashcards
A

1a = early/junctional = neoplastic melanocytes in epithelium and proliferate - flat
1b = compound stage = migrate deeper and sit between epithelium and CT - flat
2 = late/intradermal stage = melanocytes within connective tissue - dome-shaped

21
Q

how may a late-stage melanocytic naevus appear in biopsy? (2)

Study These Flashcards
A
  • purple rounded islands of melanocytes in connective tissue
  • more spindled appearance towards the bottom of the lesion (should not change throughout life)
22
Q

risk factors for malignant melanoma (4)

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A
  • genetic mutations
  • ethnicity
  • UV sun damage
  • type 1 and 2 skin (pale, red hair, blue eyes, freckling, prone to sun-related damage)
23
Q

describe malignant melanoma (what, appearance)

Study These Flashcards
A
  • de novo or progress from melanocytic naevi
  • flat or nodular lesions with suspicious signs and progression
  • rare intraorally but very poor prognosis - palate, upper alveolar ridge
24
Q

what does ABCDE mean when looking at suspicious pigmented lesions?

Study These Flashcards
A

Asymmetry
Borders (irregular)
Colour variation
Diameter >6mm
Evolution or erythema

25
intraoral sites for malignant melanoma (2)
- palate - upper alveolar ridge
26
describe how malignant melanomas develop (4)
- atypical melanocytes within epidermis - melanocytic dysplasia = increased number, pleomorphic, clusters, NO INVASION - radial growth phase = horizontal and superficially, little invasion into CT - vertical growth phase = through basement membrane into connective tissue
27
what is Breslow thickness?
measures how far a melanoma has penetrated into the skin in mm
28
histology of malignant melanoma (3)
- large clusters of S100+ melanocytes in epithelium with invasion into connective tissue - brown pigment - atypical melanocytes = dark nucleus, halo of cytoplasm
29
what is the most common oral pigmented lesion?
amalgam tattoo
30
describe an amalgam tattoo (what, appearance, histology)
- fragments of amalgam embedded into oral mucosa - often traumatic aetiology - particles distributed along collagen fibres and vessels, disperse over time = irregular outline - <5mm usually, grey-blue - histology = tiny and some larger amalgam particles associated with multinucleated giant cells
31
describe intraoral heavy metal pigmentation and give some metals that cause this
- mercury, lead, bismuth, platinum - blue-black deposits in gingival sulcus (GCF) from systemic exposure
32
describe black hairy tongue (what, aetiology)
- accumulation of keratin of filiform papillae of tongue dorsum midline - picks up stain by pigment-producing bacteria, food or smoking - uncertain aetiology but more common in heavy smokers, poor OH, drugs, radiotherapy
33
black hairy tongue management (2)
- smoking cessation - good OH and tongue scraping
34
which types of UV light have the highest and lowest energy?
C highest A lowest (all ionising)
35
UVA radiation effects (4)
(low energy) - short-lived tan - drying (indirect DNA damage) - photoaging (skin atrophy, wrinkles) - carcinoma
36
UVB radiation effects (3)
- deeper, longer-lasting tan - deep skin damage (direct DNA damage) - main cause of sunburn and skin cancer
37
UVC radiation effects
(highest energy) - no effect as it interacts with ozone layer and does not reach the ground
38
what are the effects of sunlight generally? (6)
- sunburn - photoaging - photosensitivity - actinic keratosis - carcinogenesis (lip SCC) - tan
39
describe photoaging (what, sites, histology)
- premature aging due to UV exposure - leathery nodular skin - face, ears, lips, hands, forearms - patchy hyperpigmentation (sunspots) - thickened dermis, distorted vasculature, solar elastosis
40
describe photosensitivity
immune reaction triggered by sunlight
41
describe actinic keratosis (what, presentation, demographic)
- premalignant lesion - white to brown in colour - irregular scaly plaques, in clusters in UV-exposed skin - >40yo with long history of UV exposure
42
actinic keratosis histology (3)
- increased thickness of epidermis and parakeratin layer - some degree of dysplasia/nuclear changes - superficial CT shows UV damage (collagen, elastic fibres) = pale bluish band of fibrous CT (solar elastosis)
43
describe lip SCC (risk factors, preceded by)
- risks/demographic: -- males -- outdoor/rural occupations -- renal transplants and immunosuppression -- pipe and cigarette smoking - often preceded by actinic cheilitis - fewer in dark-skinned races
44
what is actinic cheilitis? (2)
- precancerous condition from prolonged sun exposure - rough, scaly, discoloured patches on lips (esp lower lip)
45
what is a tan?
skin response to UV light causing melanin accumulation to protect against UV light
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