Red and White Patches Flashcards
What causes patches to be white?
More keratin
Hyperkeratosis
What causes patches to be red?
Atrophy
Hyperaemia
Loss of keratinisation
Give 3 reasons for white lesions?
Thickened epithelium
Organic material - candida, food debris
Physiological - tongue coating, desquamation, leukoedema
What does CLINK stand for in white patches?
Congenital
Lichen planus
Infections
Neoplastic/potentially neoplastic
Keratosis
What are the red flags indicative of SCC?
> 3 week duration
50 years old
Smoking
High alcohol
History of oral cancer
Non-homogenous
Non-healing ulcer
Induration
Exophytic
Tethering of tissue
Tooth mobility
Non-healing socket
Difficulty speaking/swallowing
Cervical lymphadenopathy
Weight loss/appetite loss/fatigue
Numbness/altered sensation
How is a SCC managed?
Urgent suspected cancer referral to maxfax
Follow local guidelines
Be honest with pt and explain concern
Explain that they will need to get a biopsy
Explain this needs to be done promptly
What is leukoplakia?
A white patch or plaque that cannot be characterised clinically or pathologically
Diagnosis of exclusion
Can’t be rubber away
0.13-34% chance of progressing to cancer
What is the difference between homogenous leukoplakia and verrucous leukoplakia?
Homogenous - uniformly white, flat and thin, has a smooth surface, may exhibit shallow cracks
Verrucous - surface is raised, Exophytic, wrinkled or corrugated
What are the strong risk factors for malignant transformation?
> 200mm^2
Non-homogenous
Red or speckled
Tongue and floor of mouth
Severe or high risk dysplasia
Give examples of disorders that can be excluded for a diagnosis of leukoplakia
Leukoedema
White sponge naevus
Frictional keratosis
Chemical injury
Acute pseudomembranous candidiasis
Hairy leukoplakia
Lichen planus (plaque like)
Lichenoid reaction (local factors and medications)
How are white patches managed?
Exclude reg flags
Does it wipe away
Get photos
Correct any obvious causes and review
If no improvement or unsure of diagnosis then refer
Does it need biopsy
How often to review - same lesion will be reviewed differently dependant on risk factors
Why do red lesions in the mouth look red?
Inflammation
Mucosal atrophy
Increased vascularisation
Mucosal/submucosal bleeding
Give differential diagnoses for red patches
Viral infection
Candida l infection
Iatrogenic - mucousitis after chemo or radiotherapy
Lichen planus/OLRs
Granulomatous disease
Vesiculobullous
Allergy
Geographic tongue
Leukaemia
Trauma
Deficiency states
Erythrolakia
What is erythroplakia?
Atrophic lesion with well defined borders
Can be speckled (erythroleukoplakia)
Fiery red arch that cannot be characterised clinically or a theologically as any other definable lesion
Strong association with tobacco use
Where are the common sites for erythrolakia?
Soft palate
Buccal mucosa
Floor of mouth
What are the stats on erythroplakia being cancerous?
51% show invasive carcinoma
40% carcinoma in situ
9% mild or moderate dysplasia
50% malignant transformation rate
May have 53 mutation
How are red patches managed?
Exclude red flags
Get photos
Correct any obvious causes
High malignant potential
If cause cant be found biopsy needed
How is OFG managed?
Refer to OM
Topical steroids - GD
Avoidance diets
Intralesional steroids
Biologics for Crohn’s - infliximab, adaliumumab (anti TNF)
