Premalignant Epithelial Lesions

Question 1

T/F: Leukoplakia is a diagnosis.

Answer 1

False

Clinical finding

Question 2

What is the most common oral precancerous lesion?

Answer 2

Leukoplakia

Question 3

T/F: A biopsy is mandatory when leukoplakia is seen.

Answer 3

True

Question 4

What causes the white color involved with leukoplakia?

Answer 4

Thickened keratin in a moist environment

Question 5

T/F: Ill-fitting dentures, poor oral hygiene, and broken teeth increase a patients risk for oral cancer.

Answer 5

False

Question 6

T/F: Moderate alcohol use by itself is a risk factor for oral cancer.

Answer 6

False

Strong synergism with tobacco

Question 7

What differentiates frictional keratosis from leukoplakia?

Answer 7

Blended borders with frictional keratosis

Question 8

T/F: Nicotine stomatitis is precancerous.

Answer 8

False

Due to heat

Question 9

What is the most common form of candidiasis?

Answer 9

Erythematous candidiasis

Question 10

How do you differentiate leukoedema from tobacco pouch keratosis?

Answer 10

Tobacco pouch keratosis does not disappear when stretched

Question 11

T/F: Gingival recession and loss of buccal bone can be associated with tobacco pouch keratosis.

Answer 11

True

Question 12

What causes the gray, translucent appearance in tobacco pouch keratosis?

Answer 12

Contact irritation - cessation of the habit will resolve lesion within 5-6 weeks

Question 13

Patient stops using smokeless tobacco for 5-6 weeks but leukoplakia is still seen at reevaluation. What to do?

Answer 13

Biopsy

Question 14

T/F: Smokeless tobacco is a bigger risk for cancer than cigarette smoking.

Answer 14

False

Smokeless tobacco has significantly less risk than cigarettes

Question 15

How is epithelial dysplasia graded?

Answer 15

Microscopic analysis:

Mild - lower 1/3
Moderate - lower 1/2
Severe - upper 1/3

Carcinoma in-situ - full thickness of epithelium

Question 16

What are some histopathological features of leukoplakia?

Answer 16

Keratosis, often sharp transition from affected to normal

Question 17

What percentage of leukoplakias show hyperkeratosis without epithelial dysplasia?

Answer 17

80% of leukoplakias show hyperkeratosis without epithelial dysplasia

Question 18

What happens to the rete ridges of epithelium as dysplasia progresses?

Answer 18

They become more bulbous and coalescent

Question 19

What percentage of patients with leukoplakia are smokers?

Answer 19

80% of patients with leukoplakia are smokers

Question 20

T/F: Brush biopsy is just as useful as scalpel biopsy.

Answer 20

False

Question 21

How do you calculate pk/yr TOB?

Answer 21

(Number of packs of cigarettes per day) x (number of years smoked)

Ex. Patient smokes 2 packs per day for 10 years = 20 pk/yr TOB

Question 22

What is the most definitive clinical feature of a leukoplakia?

Answer 22

Sharply demarcated, crisp borders

Question 23

What is the most common site for leukoplakia?

Answer 23

Buccal mucosa

Question 24

What is another term for erythroleukoplakia?

Answer 24

Speckled leukoplakia

Question 25

What is the clinical appearance of an erythroleukoplakia?

Answer 25

Red and white components

Question 26

T/F: An erythroleukoplakia is more severe than a leukoplakia.

Answer 26

True

Question 27

What is the prognosis for a leukoplakia?

Answer 27

Guarded 15% non-dysplastic lesions will transform to SCC if not treated 33% dysplastic lesions will transform 30% will recur even after complete clinical excision

Question 28

What are some definitive features of proliferative verrucous leukoplakia (PVL)?

Answer 28

Grows laterally; slow, persistent spreading Will involve multiple sites “Warty” rough projections

Question 29

T/F: PVL is seen mostly in females and has less association with smoking.

Answer 29

True

Question 30

PVL will often transform to squamous cell carcinoma within _______ years.

Answer 30

8

Question 31

T/F: Erythroplakia is has a worse prognosis than leukoplakia.

Answer 31

True

Question 32

T/F: Erythroplakia is more prevalent in men.

Answer 32

False Unlike leukoplakia, Erythroplakia has no gender predilection

Question 33

What are the most common sites of Erythroplakia?

Answer 33

Lateral tongue, floor of mouth, soft palate

Question 34

What are the clinical features of Erythroplakia?

Answer 34

Well demarcated, velvety red patches

Question 35

What percentage of Erythroplakia show severe epithelial dysplasia or worse at the time of biopsy?

Answer 35

90%

Question 36

What are the highest risk sites for leukoplakia?

Answer 36

Ventral tongue, floor of mouth, soft palate/tonsillar pillars

Question 37

What is a major risk factor for oral submucous fibrosis?

Answer 37

Betel quid, paan, masala, gutkha, mawa *Indian subcontinent, Southeast Asia, etc.

Question 38

What are the clinical features of oral submucous fibrosis?

Answer 38

Pallor and fibrosis (white color) to soft palate with the uvula retaining normal color *burning and intolerance to spicy foods, limited incisal opening

Question 39

T/F: Oral submucous fibrosis will regress with habit cessation.

Answer 39

False

Question 40

T/F: Actinic keratosis is caused by UV rays.

Answer 40

True

Question 41

A light skinned 51 yr old male has a scaly plaque with sandpaper texture on his forehead. Likely diagnosis?

Answer 41

Actinic keratosis

Question 42

What is likely seen histopathologically with actinic keratosis?

Answer 42

Hyperkeratosis, solar elastosis, epithelial dysplasia

Question 43

What is the term for actinic keratosis involving the vermilion zone of lips?

Answer 43

Actinic cheilitis

Question 44

Who is the most likely to get actinic cheilitis?

Answer 44

male over 45 with fair skin

Question 45

What are some major clinical features of actinic cheilitis?

Answer 45

Dryness, fissures, blended vermillion border Dry portions may thicken and become leukoplakias

Question 46

T/F: Hyperkeratosis may be seen in actinic cheilitis and actinic keratosis.

Answer 46

True

Question 47

T/F: Actinic cheilitis is more likely to become cancer than actinic keratosis.

Answer 47

True

Question 48

T/F: Actinic cheilitis has a better prognosis than intraoral SCC.

Answer 48

True