question 38 Flashcards
(6 cards)
white patch on FOM
differential diagnosis
- Differential diagnoses of white lesion:
o Hereditary
Oral white sponge naevus
o Smokers keratosis
Usually in palate, may also see melanosis
Low malignant potential
o Frictional keratosis
Associated with obvious traumatic cause – loose dentures, parafunctional grinding/clenching
o Lichenoid reaction or lichen planus
o Candidal leukoplakia
Acute pseudomembranous candidiasis – can it be scraped off?
Chronic hyperplastic candidosis
o Carcinoma
o Leukoplakia
White patch that can’t be rubbed off or attributed to any other cause
Can occur 6x more frequently in smokers – common in FoM
Risk of malignant transformation
Stopping smoking may cause lesion to disappear
white patch FOM
when to refer
o If lesion has an inflammatory margin - erythematous
o If lesion is without cause on lateral tongue, FoM and soft palate area
o Risk factors present – smoking, alcohol
o Family history of oral cancer
white patch FOM
what to discuss with patient
- Explain to patient white lesion on FoM has a number of possible causes. Some of these are harmless and benign, however some causes could potentially be more serious and potentially cancerous. As this is a site that is high risk for oral cancer, and you possess a few of the risk factors for oral cancer, it would be appropriate to refer you on to have this looked at by a specialist. This will involve someone more specialised having a look at the lesion and a biopsy taken so that we can see the type of cells present in the lesion and therefore a diagnosis.
- Explain to pt that we may take some photographs to monitor lesion and send with referral – 2 week rule for referrals
- Explain what biopsy will involve
white patch FOM
what is risk factors and how to reduce risk
- Tobacco and alcohol – synergistic effect if both present
- Diet low in ACE vitamins – increase fruit and veg
- Sunlight exposure
- Pre-existing mucosal abnormalities
- HPV in younger age groups
- Low socioeconomic status
white patch FOM
types of potentially malignant lesions
o White lesions (leukoplakia) – very small chance
o Red lesions (erythroplakia) – less frequent, but higher cancer risk
o Lichen planus
o Chronic hyperplastic candidiasis
white patch FOM
oropharyngeal cancer symptoms
o Red or white patch, Rasping or hoarseness
o Ulceration
o Lump, loose teeth or lymphadenopathy
o Extending for 3 weeks or more
o Refer
o May also have dysphagia or persistent pain in throat
