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BDS4 Oral Medicine > Other mucosal colour changes > Flashcards

Other mucosal colour changes Flashcards

1
Q

What is erythematous candiosis

A

aka atrophic candidosis
appears red/raw

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2
Q

What are the most common causes of erythematous candidosis

A
  • denture induced
  • antibiotic induced
  • steroid induced
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3
Q

What is acute erythematous candidosis commonly associated with

A

AB/steroid

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4
Q

What is chronic erythematous candidosis commonly associated with

A

dentures

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5
Q

What is angular cheilitis

A

inflammation typically seen at the angles (commissures of the lip)
usually caused by candida

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6
Q

What are predisposing factors to angular cheilitis

A
  • denture wearing
  • deficiency states
  • reduced OVD - lip anatomy
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7
Q

What species is angular cheilitis usually associated with

denture related

A

candida

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8
Q

What species is angular cheilitis usually associated with when not denture related

A

streptococci
staphylococci

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9
Q

What is the treatment for angular cheilitis

A
  • miconazole cream 2%
  • 20g tube
  • apply to angles of the mouth twice daily
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10
Q

When should sodium fusidate ointment be used for angular cheilitis

A
  • if patient is on warfarin/statin
  • clearly bacterial cause
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11
Q

What is the difference between a cream and an ointment

A
  • cream is used on wet surfaces
  • ointment is used on dry
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12
Q

If angular cheilitis is not responding to first line tx, what should be given

A

miconazole + hydrocortison cream/ointment

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13
Q

What are possible differntial diagnosis for dark blue lesions

A

likely due to slow moving blood
often haemangioa (cavernous)

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14
Q

What are possible differential diagnosis for light blue lesions

A

saliva (mucocele)
lymph (lymphangioma)

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15
Q

What is a hamartoma

A

Benign growth made up of an abnormal mix of cells and tissues normally found in that area

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16
Q

What is a haemangioma

A
  • type of hamartoma
  • vascular malformation
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17
Q

What is a capillary haemangioma

A

Made up of small capillaries that are normal in size but high in number

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18
Q

What is a capillary haemangioma

A

Made up of small capillaries that are normal in size but high in number

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19
Q

What is a cavernous haemangioma

A
  • made of larger blood vessel that is dilated
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20
Q

Where are haemangiomas common

A

tongue
vermillion border
buccal mucosa

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21
Q

What is a lymphangioma

A
  • type of hamartoma
  • benign neoplasm of lymphatic channels
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22
Q

What are the types of lymphangioma

A
  • cavernous (most common on tongue)
  • cystic hygroma
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23
Q

What are the different vasculitic disease

A
  • large vessel disease
  • medium vessel disease
  • small vessel disease
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24
Q

What is an example of large vessel disease

A

giant cell (temporal) arteritis

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25
Q

What are examples of medium vessel disease

A

polyarteritis nodosa
kawasaki disease

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26
Q

What is an example of small vessel disease

A

granulomatosis with polyangitis

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27
Q

What are the broad 3 causes of mucosal pigmentation

A
  • exogenous staining
  • intrinsic pigmentation
  • intrinsic foreign body
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28
Q

What can cause exogenous stain

A

tea, coffee, CHX
bacterial overgrowth

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29
Q

What are causes of intrinsic pigmentation

A
  • reactive melanosis
  • melanotic manule
  • melanoma
  • effect of systemic disease
  • paraneoplastic phenomenon
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30
Q

What are examples of intrinsic foreign body

A

metals eg. amalgam/arsenic

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31
Q

What are causes of localised brown/black lesions

A
  • amalgam
  • melanocytic macule
  • melanotic naevus
  • malignant melanoma
  • peutz-jehger’s syndrome
  • pigmentary incontinence
  • kaposi’s sarcoma
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32
Q

What are causes of generalised black/brown lesions

A
  • racial pigment
  • smoking
  • drugs e.g OCP / tetracycline
  • addison’s disease (raised ACTH conditions = more melanocyte stimulation)
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33
Q

How does amalgam tattoo occur

A

macrophages (giant cells) try to phagocytose the amalgam unsuccessfully
the cells move elsewehere and spread out over time

34
Q

When should mucosal pigmentation be referred

A
  • if it is not easily explained
  • if it is increasing in size, colour, quantity
  • if there is any new sysetmic problems
35
Q

What are the signs of a melanoma

A
  • variable pigmentation
  • irregular outline
  • raised surface
  • symptomatic - itch and bleed
36
Q

Why is biopsy important

A

identifies or excludes malignancy
identifies dysplasia
identifies other disease e.g lichen planus

37
Q

When should a white/red/pigmented patch be biopsied

A

if unexplained

38
Q

When should a white/red/pigmented patch be biopsied

A

if unexplained

39
Q

What should be referred to oral medicine

A
  • patients with abnormal or unexplained changes to oral mucosa
  • if there is concern about dysplasia risk
40
Q

What can make a practitioner concerned about dysplasia risk

A
  • appearance of lesion
  • risk site
  • risk behaviour
  • family history e.g oral cancer history
41
Q

What should not be referred to oral medicine

A
  • asymptomatic variations of normal mucosa
  • benign conditions the practitioner has diagnosed that are asymptomatic, do not have potentially malignant risk, no tx available
  • if unsure consider photography and monitor area until next check up + send for specialist opinion if required
42
Q

How can the differential diagnosis for red lesions be remembered

A

BLING
blood disorders
lichen planus/lupus erythematous
infection/inflammation
neoplasm/preneoplastic
geographic tongue

43
Q

What is the most concerning red lesion

A

erythroplakia

44
Q

What type of lichen planus causes red lesions

A

atrophic

45
Q

What are examples of red neoplasms

A

peripheral giant cell tumour
angiosarcoma e.g kaposi sarcoma (linked to HIV/AIDS)
squamous cell
lymphoma

46
Q

What is the other name for geographic tongue

A

erythema migrans

47
Q

How does geographic tongue appear

A
  • discount prominent red lesion on the dorsum of the tongue
  • common cause of a sore tongue
48
Q

What is the clinical appearance of geographic tongue

A
  • irregular red depapillatde map like areas
  • may be surrounded by a thicker yellow border
  • increased thickness of the intervening filiform papillae
49
Q

What investigations may we want to do for red lesions

A

biopsy
fbc
serum ferritin, b12, folate
swab

50
Q

What are the most common vascular anomalies

A

varices
haemangioma
lympangioma

51
Q

What are varices

A

dilated lingual veins

52
Q

Where are the common areas for hamangioma

A

tongue
vermillion border
buccal mucosa

53
Q

What are causes of extrinsicly discoloured pigmented lesions

A

food/drink
drugs
tobacco

54
Q

What are causes of intrinsic pigmented lesions

A

phsyiological
melanotic macule
melanocytic naeuvus
melanoma

55
Q

What is a melanotic macule

A
  • single, brown, collection of melanin containing cells
56
Q

What is the clinical presentation of melanotic macule

A

<1cm and flat
contain increased melanin
looks like a freckle
painless
seen commonly in vermillion border and palate

57
Q

What is melanocytic naeuvus

A

blue/black lesions
Benign proliferation of the nevus cells (melanocytes)
uniform colour and borders
don’t change in size or surface texture

58
Q

What is the clinical presentation of melanocytic naevus

A
  • usually <1cm
  • painless
  • generally dont change in size
  • particularly seen on the palate
59
Q

What are the clinical features of mucosal melanoma

A
  • rare
  • may arise in normal mucosa or in a pre-existing nauvus
  • usually in palate/maxillary gingivae
60
Q

What are the red flag features for pigmented lesion that point towards melanoma

A
  • rapid increase in size
  • change in colour
  • ulceration
  • pain
  • lymph node enlargement
61
Q

What is an amalgam tattoo

A
  • localised blue/black lesion
62
Q

What causes amalgam tattoo

A
  • due to introduction of amalgam into soft tissues during dental procedures
63
Q

What dental procedures may result in amalgam entering the soft tissue

A
  • placement, removal or polishing of rest
  • XLA - amalgam falling into socket
  • retrograde filling of a root canal after apicectomy
64
Q

If a diagnosis of amalgam tattoo cannot be made definitively, what should be done to disclude melanoma

A

biopsy

65
Q

What happens on a histopathological level in amalgam tattoo

A
  • macrophages/giant cells attempt to phagocytose the foreign body with little success
  • can see multiple black deposits in the slides
  • foreign material elicits a foreign bdoy reaction including lymphocytes and giant cells
66
Q

What is kaposi sarcoma

A

type of cancer
can occur on skin, lymph nodes, mouth and other organs

67
Q

What is the main cause of kaposi sarcoma

A

immunosuppression e.g HIV/AIDs + infection by HHV8

68
Q

What is the appearance of kaposi sarcoma

A

red/blue or purple macular/nodular lesion
size ranges from small to extensive
diagnosis made via histopathology

69
Q

What is a macule

A

flat, non-palpable lesion usually <10mm in diameter e.g freckle

70
Q

What is a papule

A
  • elevated lesion
  • usually <10mm
  • can be felt by palpation
  • e.g papular lichen planus
71
Q

What are plaques

A
  • palpable lesions >10mm in diameter
  • elevated/depressed compare to surface
72
Q

What are causes of generalized pigmentation

A
  • smoking
  • hypoadrenalism
  • drugs
73
Q

What is the differential diagnosis for a localised pigmented lesion

A
  • melanotic macule
  • melanocytic naevus
  • melanoma
  • amalgam tattoo
  • kaposi sarcoma
74
Q

How does smoking result in generalised pigmentation

A

has an effect on the melanocytes
called smoker’s melanosis

75
Q

How does hypoadrenalism result in generalised pigmentation

A

adrenal gland is impacted and so there is reduced production of aldosterone and cortisol
reduced production causes negative feedback system to produce more ACTH
ACTH mimics MSH and results in increased melanin production

76
Q

What is the cortisol production pathway

A

hypothalamus produces corticotrophic releasing hormone which acts on anteriro pituitary gland to produce adrenocorticotrophic hormone and this hormone acts on adrenal cortex

77
Q

What drugs can result in generalised pigmentation

A

OCP - oestrogen and progesterone can effect melanocytes
tetracycline
antimilarials
acth therapy

78
Q

What are the 3 categories of endogenous pathological pigmentation

A

melanin
blood derived pigments e.g haemosiderin
lipofuscin

79
Q

What are melanophages

A

macrophages that have phagocytoses pigment
often seen in the lamina proprietor as they have phagocytosed pigment derived from the epithelium

80
Q

Where are melanocytes naturally located

A

basal cell layer of the epithelium

81
Q

What is secondary melanosis

A

aka reactive melanosis
when pigmentation is associated with abnormal epithelium
most frequent reason is due to smoking

82
Q

How do melanocytes appear on histological slides

A

rounded
paler stained nuclei
these cells are not normally pigmented
the melanin they produce gets injected into the adjacent keratinocytes

BDS4 Oral Medicine (17 decks)

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