Oral Precancerous Lesions

Question 1

85% of oral precancers are?

Answer 1

Leukoplakias

Question 2

A simple definition of leukoplakia is?

Answer 2

Suspicious white patch

Question 3

What are 4 factors in the development of leukoplakia?

Answer 3

Tobacco smoking, sanguinara, UV, microorganisms

Question 4

Who typically gets leukoplakia?

Answer 4

Men over 40

Question 5

Where do most leukoplakia occur?

Answer 5

Lip vermilion, buccal mucosa, gingiva

Question 6

Is leukoplakia a microscopic diagnosis?

Answer 6

No just a clinical impression

Question 7

Describe a mild/thin leukoplakia

Answer 7

Grey-white with sharply defined borders, soft, slightly elevated

Question 8

Which variant of leukoplakia has the highest risk of malignancy?

Answer 8

Erythroleukoplakia, a white plaque with scattered red patches

Question 9

Most leukoplakias exhibiting dysplasia or carcinoma are in what locations?

Answer 9

Tongue, lip vermilion, floor of mouth

Question 10

Most cases of leukoplakias are what microscopically?

Answer 10

Benign hyperkeratosis

Question 11

What percentage of leukoplakias become SCC? What percentage are malignant initially?

Answer 11

4 and 5% respectively

Question 12

What percentage of dysplastic leukoplakias become malignant?

Answer 12

10-15%

Question 13

Which gender has a higher risk of malignant transformation?

Answer 13

Female

Question 14

How is malignant transformation typically predicted?

Answer 14

Histopathologic grading of dysplasia

Question 15

What 3 markers indicate a possible evolution to cancer?

Answer 15

p16, p53, and ki-67

Question 16

What does the term sublingual keratosis refer to?

Answer 16

Leukoplakias on the ventral surface of the tongue, floor of mouth, and lingual aspect of the mandibular alveolar mucosa. These have a high risk for dysplasia and carcinoma

Question 17

A high risk form of leukoplakia with multiple white plaques and roughened surface projections is?

Answer 17

Proliferative verrucous leukoplakia

Question 18

Most cases of proliferative verrucous leukoplakia occur in ?

Answer 18

Elderly women with no risk factors

Question 19

How does erythroplakia compare to leukoplakia in terms of frequency and risk of malignancy?

Answer 19

Less common but more likely to be malignant

Question 20

Erythroplakia presents as?

Answer 20

A red patch that cannot be classified as any other condition

Question 21

In the US, most cases of erythroplakia are seen in?

Answer 21

Elderly men

Question 22

Where are most cases of erythroplakia seen?

Answer 22

Floor of mouth, tongue, retromollar-tonsillar pillar, soft palate complex

Question 23

How do most cases of erythroplakia appear microscopically?

Answer 23

90% are malignant or dysplastic

Question 24

The epithelium in erythroplakia can be described as?

Answer 24

Non-keratinized and atrophic

Question 25

Reverse smoking is associated with?

Answer 25

Dysplasias and cancers of the palate

Question 26

The dysplasias of the palate seen in reverse smoking are called?

Answer 26

Nicotine palatinus

Question 27

What changes in the mucosa are seen with use of smokeless tobacco?

Answer 27

Rippled, faintly white mucosa

Question 28

How long does it take for smokeless tobacco keratosis to reverse?

Answer 28

6 weeks

Question 29

What type of smokeless tobacco carries the greatest risk of oral cancer?

Answer 29

Dry snuff

Question 30

Keratosis associated with betel chewing is strongly or weakly associated with dysplasia and SCC?

Answer 30

Strongly

Question 31

Where is betel quid used?

Answer 31

South Asia

Question 32

What are two consequences of betel quid use?

Answer 32

Submucous fibrosis and epithelial dysplasia/carcinoma

Question 33

Can betel quid without tobacco be carcinogenic?

Answer 33

Yes

Question 34

Submucous fibrosis typically affects who?

Answer 34

Young and middle aged adults

Question 35

The progressive mucosal stiffening in submucous fibrosis leads to?

Answer 35

Marblelike pallor that progresses to trismus

Question 36

What tissues are seen in sub mucous fibrosis?

Answer 36

Very dense collagenous fibrous connective tissue with chronic inflammation

Question 37

What epithelial changes are seen in dysplasia associated with betel chewing?

Answer 37

Sub epithelial vesicles in early lesions | Hyperkeratosis with marked atrophy in older lesions

Question 38

How much does oral sub mucous fibrosis increase the risk of getting oral cancer?

Answer 38

19x

Question 39

What is betel chewers' mucosa

Answer 39

A benign change in which the mucosa becomes brown/red

Question 40

What is actinic cheilosis

Answer 40

A pre malignancy of the lower vermilion due to UV

Question 41

Who typically gets actinic cheiolosis

Answer 41

Fair skinned elderly men

Question 42

What are the first clinical signs of actinic cheilosis?

Answer 42

Atrophy of the lower lip vermilion with smooth surface and blotchy pale areas

Question 43

The epithelium in actinic cheilosis can be described as?

Answer 43

Atrophic with heavy keratin