Premalignant lesions

Question 1

what is the definition of Leukoplakia?

Answer 1

White patch of the oral mucosa that cannot be scraped off and cannot be diagnosed clinically as any other condition

Question 2

T/F: Leukoplakia that persists or progresses must be biopsied

Answer 2

true

Question 3

what are some differential diagnoses for leukoplakia?

Answer 3

Leukoedema
Cheek chewing
Frictional keratosis
Nicotine stomatitis
Smokeless tobacco keratosis
Aspirin burn
Candidiasis
Lichen planus
White sponge nevus
Cinnamon reaction

Question 4

what population groups are at the highest risk for leukoplakia?

Answer 4

Older adult males (>40 years of age)
Tobacco use (cigarettes), UV exposure

Question 5

leukoplakia is most commonly found in what sites in the oral cavity?

Answer 5

lip vermilion (UV), buccal mucosa, gingiva (70%)

Question 6

leukoplakias in what areas of the mouth have the highest risk for dysplasia?

Answer 6

tongue, floor of mouth, lip vermilion

Question 7

name the clinical features of a leukoplakia lesion

Answer 7

Sharply-demarcated (well-defined) white plaque with variable surface (smooth, wrinkled, micronodular)

Question 8

if there is a red component in a leukoplakia lesion, what is it called?

Answer 8

“speckled leukoplakia”

erythroleukoplakia

Question 9

name the Histological characteristics of leukoplakia

Answer 9

A) Hyperkeratosis (wet keratin appears white)

B) Abrupt transition from normal epithelium

C) Precancerous (dysplastic) change or carcinoma (5-25%; average of ~10%)

Question 10

what is the treatment for leukoplakia?

Answer 10

Treatment is controversial

For no dysplasia or mild dysplasia - D/C carcinogenic habits; watch?

For moderate dysplasia or worse - remove by the most convenient means available

Question 11

describe the prognosis for leukoplakia:

what will transform, what % will recur

Answer 11

Prognosis is guarded
15% of non-dysplastic lesions will transform if not treated
33% of dysplastic lesions will transform
30% of leukoplakias will recur

Question 12

____________ is defined as “A red patch that cannot be diagnosed as any other condition clinically”

Answer 12

Erythroplakia

Question 13

T/F: Erythroplakia is less serious than leukoplakia, but has the same epidemiologic features and risk factors

Answer 13

FALSE

Erythroplakia is more serious

Question 14

what are the clinical characteristics of Erythroplakia? what areas of the mouth does it affect?

Answer 14

Velvety red, well-demarcated patch

usually affecting the lateral tongue, floor of the mouth or soft palate

Question 15

Microscopically, __%of Erythroplakia lesions are severe epithelial dysplasia or worse at the time of biopsy

Answer 15

90%

Question 16

what causes the red appearance of Erythroplakia lesions?

Answer 16

due to the lack of keratin production on the surface of the lesion

Question 17

T/F: When initially diagnosed, most erythroplakia lesions are higher grade lesions than leukoplakia lesions

Answer 17

true

Question 18

what is the definition of Actinic (solar) Keratosis?

what is its clinical appearance?

Answer 18

Premalignant sun-induced skin lesion caused by chronic UV exposure

Scaly plaque with reddish base and sandpaper texture

Question 19

where are Actinic (solar) Keratosis lesions usually found?

what population group do they usually effect?

Answer 19

Common on facial skin and vermilion zone of the lower lip in fair-skinned persons over 40 years of age

Question 20

describe the histological findings of Actinic Keratosis:

Answer 20

Hyperkeratosis (white) and epithelial atrophy (reddish)

Some degree of epithelial dysplasia or carcinoma-in-situ (by definition)

Question 21

Actinic (solar) keratosis lesions generally give rise to what type of cancer?

Answer 21

Gives rise to invasive squamous cell carcinoma

Question 22

how are Actinic keratosis lesions treated?

Answer 22

Skin lesions treated with topical liquid nitrogen, surgical excision, laser ablation, 5-fluorouracil (5-FU, Effudex) or imiquimod (Aldara)

Question 23

T/F: Patients that have had actinic keratosis must be continually monitored for new lesions

Answer 23

true

Question 24

what is Actinic Cheilosis (Cheilitis)?

Answer 24

Term for actinic keratosis involving the vermilion zone of the lower lip

Question 25

what is the clinical presentation for Actinic Cheilitis (cheilosis)?

Answer 25

Chronic scaling, ulceration, atrophy and/or fissuring of the lip

Question 26

how are Actinic Cheilitis lesions treated?

Answer 26

1) Vermilionectomy with advancement of the labial mucosa or laser ablation of the involved vermilion zone
2) 5-FU and imiquimod in selected cases
3) Patients should use sun block/sun avoidance with long term follow-up