Quiz 3 Flashcards by Victoria Hanna

4 common locations for oral melanotic macules

Vermillion border of lower lip
Bucal mucosa
Mx anterior gingiva
Palate

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5 common places to see racial pigmentation

Gingiva
Buccal mucosa
Lips
Palate
Tongue

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Tx for melasma

Topical cream with:
4% hydroquinone
.05% tretinoin
.01% fluocinolone acetonide

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Incidence of melasma

Pregnancy
V rare in men
Face of Asian or Hispanic women

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Etiology of oral melanoacanthoma

Acquired

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Clinical presentation of oral melanoacanthoma

Fast growing lesion in buccal mucosa

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Etiology of oral melanotic macules

Increased melanin in basal cell layer + superficial CT WITHOUT melanocytic activity

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Incidence of smoker’s melanosis

Heavy smokers

Japan - kids of heavy smokers

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What is melasma

Symmetric diffuse hyperpigmentation of sun exposed skin

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Incidence of ephelis (ephelides)

Fair haired
NO gender predilection
Genetic
1st decade (less prominent in adults)

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Carcinoma of the Mx sinus is (weakly) assoc with

Tobacco

Nasal polyps

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Is staging or grading of oral SCC done first?

Staging

2. Grading (histology)

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⅓ of oral melanoma pts have ____ in the area

Macule

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Ephelis (ephelides)

aka freckles

Hyperpigmented macule caused by increased melanin WITHOUT defect in melanocytes

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Risk of malignant transformation -oral melanoacanthoma

NONE - benign

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Rank the common sites of oral SCC in terms of their overall 5 year survival estimates

Lip - 88% (best)
Tongue + oropharynx - 65%
Floor of mouth - 54% (worst)

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6 risk groups/factors for basal cell carcinoma

UV exposure (incl. freckles in childhood)
Psoriasis therapy (psoralen, UV A)
Ionizing radiation exposure
Immunosuppression
Arsenic ingestion
Genodermatoses (Gorlin syndrome, xenoderma pigmentosum, albinism)

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Solar lentigo - malignant transformation potential

NONE

But - presence of lesions indicate sun damage = pt might be at higher skin cancer risk

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Psoralen + UV A are used to treat ______ and is associated with a higher risk for _____

Psoriasis therapy

Basal cell carcinoma

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Melanoma is the ____ most common skin cancer

3rd

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2 risk factors for verrucous carcinoma

Smoking

HPV (possibly)

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Smokers melanosis develops in heavy smokers because melanin plays a role in ______

Melanin plays a role in the detoxification of nicotine + benzopyrene

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Ephelis (ephelides) has a genetic predilection - assoc with what gene

Melanocortin-1-receptor gene

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Oral SCC treatment depends on what?

Clinical stage

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Does solar lentigo change after UV exposure like freckles?

What are the 4 reasons why verrucous carcinoma as a good prognosis?

Slow growing Well differentiated Minimal/no dysplasia Rarely metastasizes

3 common locations for oral melanocytic nevi

Palate Mucobuccal fold Gingiva

For cancers of the oral cavity + lip, a higher stage is associated with a dramatic drop in 5 year survival rates. Why is this not the case with cancers of the oropharynx?

Survival rates are better bc of the increasing incidence of HPV related cases

Most common cancer

Basal cell carcinoma

Give 2 examples of targeted + immunomodulatory therapy used to tx oral SCC

Monoclonal antibodies | Tyrosine kinase inhibitors

SCC tumors in lower lip +/or floor of mouth mets via...

Submental nodes

Why are DDS/DHs the most important people in fight to improve survivability of oral cancer

Early detection (@ dysplasia stage) is most effective means of saving lives

Oral SCC distantly mets (below clavicle) common locations (3) *only happens in 2% of cases

Lung Liver Bones

Incidence of oral melanotic macules

Women 2x> men | 5th decade

What determines the grade of oral SCC?

Histology

Clinical appearance of lentigo simplex

``` Single or multiple Any surface (even if not sun exposed) Small Uniform Tan to brown/black ```

In women, smokers melanosis is assoc with

Synergistic effect of hormones

List 3 examples of the platinum-containing cheotherapeutic drugs commonly used to treat oral SCC

Cisplatin 5-fluouracil Taxanes

SCC tumors of the posterior mouth mets via...

Superior jugular nodes | Digastric nodes

Does lentigo simplex have malignant transformation potential?

Metastasis of oral SCC goes through ______ to _____

Lymphatics to the IPSILATERAL cervical lymph nodes

Incidence of oral melanoma

<1% all melanomas | More common in other countries (Japan)

3 reasons why oral SCC dx might be delayed

1. Some regions (i.e. base of tongue) often go undetected until late stage 2. Majority of dentists don't do oral cancer screen at routine visits 3. Sometimes an adult w neck node gets Rx antibiotics (delays dx)

Prognosis of oral melanoma

POOR 5 yr survival = 45% 10 yr = 28%

What country has the highest rates of BCC?

Austrailia

Are oral melanocytic nevi acquired or congenital?

Acquired | RARELY congenital

Solar (actinic) lentigo is a result of _____ caused by ______

Melanocytic hyperplasia caused by UV exposure

5 common locations to see smoker's melanosis

``` Anterior facial gingiva Floor of mouth Buccal mucosa Lips Hard palate ```

Incidence of oral melanoacanthoma

UNCOMMON Almost exclusively Black Female predilection

Basal cell carcinoma is associated with mutations in _________, which is involved in _______

Patched gene Involved in the sonic hedgehog pathway

TNM staging ONLY applies to which cancers?

HPV negative

Where do you typically see smoker's melanosis in: Cigarette smokers Pipe smokers Reverse smokers

Cigs - gingiva Pipe - buccal mucosa, commissures Reverse - hard palate

BCC is ____ invasive and ____ spreading

Locally invasive | Slow spreading

Incidence of BCC in North America

Increase recently in aging population + young women

Lentigo simplex might be a precursor to...

Melanocytic nevi

Racial pigmentation can present in ____ papillae

Fungiform papillae

What are 9 clinical prognostic factors for cases of oral SCC (predict how the pt will fxn post-tx)

1. Performance status + comorbidities 2. Primary site of disease 3. Tumor stage 4. Depth of invasion 5. Nodal stage 6. Total tumor burden 7. Post-surgical margin 8. Histological grade 9. Response to chemo

How do oral melanotic macules differ when they are intraoral vs. labial

Intraoral macules are larger than labial macules

How can you differentiate between racial pigmentation and a pathologic process

Racial pigmentation is usually diffuse + bilateral

7 risk factors for recurrence of BCC

1. Lesion 6mm(+) in 'mask area' of face 2. Lesion 1cm(+) outside 'mask area' 3. Ill defined borders 4. Micronodular, infiltrative, sclerosing types 5. Perineural invasial 6. Recurrent lesions 7. Immunosupporessed pts or sites of radiation tx

Carcinoma of the Mx sinus can extend to _____

Palate

Lentiginosis profusa Peutz Jeghers LEOPARD Xeroderma pigmentosum These are rare syndromes associated with...

Multiple lentigo simplex lesions

What do metastatic (cervical) lymph nodes feel like upon palpation?

Firm | Feel 'fixed'

Oropharyngeal SCC tumors mets via...

Jugulodigastric nodes | Retropharyngeal nodes

Which skin cancer causes the most deaths

Melanoma

Lentigo simplex lesions are typically _____ than solar lentigo lesions - is the color intensity related to sun exposure?

Darker | Color intensity are NOT related to sun exposure

Overall survival of oral SCC patients falls by _____ from stage I/II to stage III/IV, making early dx critical

Half

What 4 things can cause lesions that are similar to melasma?

Oral contraceptives Hormone replacement therapy Thyroid disorders Certain drugs + cosmetics

Oral melanoma makes up ___% of all melanomas

<1% of all melanomas

Carcinoma of the Mx sinus mimics...

The inflammatory process

4 types of melanoma

Superficial spreading Nodular Lentigo maligna Acral lentigenous

Does melanoma always have a premalignant lesion?

No Can be from benign melanocytic lesion or de novo

Solar lentigo clinical appearance

``` On face (not in mouth) .5-1 cm Sharply circumscribed Single or multiple No change after sun exposure ```

Verrucous carcinoma can present basically anywhere in the OC - what are the 5 most common sites (in order)

1. Md vestible 2. Buccal mucosa 3. Gingiva 4. Tongue 5. Palate

Incidence of basal cell carcinoma (in general)

``` White >40 yrs Fair complexion Red + blonde hair Blue/green eyes Men > women ```

Chemotherapeutic drugs used to treat oral SCC contain ______

Platinum

Oral melanoma is ______ than cutaneous melanoma

More aggressive

Clinical appearance of ephelis (ephelides)

Small Uniform color NOT as dark as lentigo simplex More pronounced post-sun

Gorlin syndrome

aka nevoid basal cell cercinoma syndrome Genodermatoses (genetic skin disorder) associated with basal cell carcinoma

Basal cell carcinoma arises from

Basal cells

Nasopharyngeal carcinoma is usually associated with an environmental causing agent. List 3 examples

Epstein Barre Virus Low vitamin C Salt fish

Lentigo simplex, like solar lentigo, is a result of

Melanocytic hyperplasia

Where do you see lentigo simplex lesions

Any skin surface | Including skin not exposed to sun

Common sites for oral melanoma

Hard palate | Mx alveolus

Melasma occurs usually in pregnancy bc ______

Estrogen + progesterone play a role

3 different clinical types of BCC

Noduloulcerative (nodular) Pigmented Sclerosing

Most common skin cancer

Basal cell carcinoma

SNUC, adenoca, SCCa, neuroendocrine are different types of...

Carcinoma of the mx sinus

Metastatic lymph nodes feel fixed bc...

Tumor has spread outside capsule