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Flashcards in White Lesions Deck (112):
1

Reasons lesions may be white:

1. Intracellular edema 2. Plaques 3. Reduced vascularity 4. Fungal colonies

2

White lesions that can be scraped off

  1. White coated tongue
  2. Pseudomembranous candidiasis
  3. Thermal burn
  4. Sloughing traumatic lesion
  5. Toothpase reaction
  6. Chemical burn

3

White lesions that can't be scraped off:

  1. Heridirary conditions
  2. Reaction lesions
  3. Preneoplastic lesion
  4. Lesions due to EBV

4

Which herditary lesion is not a true one?

Leukoedema

5

Features of leukoedema

  • General opacification of buccal mucosa 
  • Asymptomatic 
  • BILATERAL

6

Why does leukoedema have a grayish-white color?

It's more common in African-Americans 

7

Common populations with leukoedema

Smokers and African Americans

8

Pathognomonic sign of leukoedema

Disappears when the mucosa is stretched 

9

Histopathology of leukoedema

Q image thumb

Epithelium: parakeratotic and acanthotic

Spinous layer: intracellular edema 

Enlarged cells with lots of clear cytoplasm and small nucleus 

 

10

Two important tests for white lesions

1. Scrape it 

2. Stretch it 

11

DD of leukoedema

  • White sponge nevus 
  • HBID
  • Chronic cheek biting 
  • Lichen planus 

12

What is the etiology of lichen planus 

Unknown etiology, but it is NOT autoimmune

13

T/F Leukoedema has a patch and is elevated

FALSE

14

White sponge nevus 

Keratin 4 or 13 mutation

15

Features of white sponge nevus

  1. BILATERAL
  2. NOT on skin
    1. Occurs on GI, genital, and oral tract 
  3. Younger patients 
  4. No pain 

16

Histopathology of WSN

  1. Thick epithelium 
  2. Parakeratosis 
  3. Acanthosis 
  4. Perinuclear eosinophilic condensation of cytoplasm of prickle cells 

17

HBID stands for: 

Hereditary benign intraepithelial dyskeratisis 

18

Who does HBID happen in

Triracial isolate: Caucasian, Native American, and AA in North Carolina 

19

Key clinical feature of HBID

  1. Bulbar conjunctivitis 
  2. Conjuctival plaques
  3. Foamy gelatinous plaques in the eye and orally
  4. White oral lesions 

20

What mucosa involved in HBID

ANY mucosa including BILATERAL

21

Histopath of HBID

Hyperplasia

Acanthosis 

Intracellular edema of the epithelium

22

Etiology of frictional keratosis 

Chronic rubbing or friction

23

Clinical presentation of frictional keratosis 

  • Gray or gray/white 
  • Ill-defined margin

24

Common locations of frictional keratosis 

Lip

Buccal mucosa 

Tongue 

Alveolar ridge 

25

Histopath of frictional keratosis 

Hyperkeratosis 

Scattered inflammaroty cells in CT 

 

26

Tobacco Pouch Keratosis etiology 

  • Chronic smokeless tobacco use

27

Population high in tobacco pouch keratosis 

White males 

28

Clinical features of TPK

  • Color: grey-white 
  • Appearance: leathery with fissured surface 
  • Location: mandibular buccal fold 

29

Histopath of TPK

  • Hyperkeratosos 
  • Acanthosis 
  • Parakeratin chevrons
  • Basophilic stromal alteration next to salivary glands
  • Occasional dysplasia 
    • SCC possible 

30

Nicotine stomatitis etiology

  • Pipe/cigar smokin'
  • Drinking hot coffee/tea 

 

31

Nicotine stomatitis clinical features 

  • Men > 45 years 
  • Gray or white palatal mucosa 
  • Papules with punctate red centers 

 

32

Histopath of nicotine stomatitis 

  • Hyperkeratosis 
  • Acanthosis
  • Salivary glands with hella inflame
  • Excretory ducts squamous metaplasia 

33

Hairy leukoplakia etiology

  • EBV VIRUS
  • Homosexual men with HIV/AIDS 

34

Hairy leukoplakia clinical features 

  1. Flat white plaques 
  2. Vertical white corrugated lines on side of tongue 
  3. Unilateral or bilateral 

35

Hairy leukoplakia histopath

  • Hyperkeratosis 
  • Beading of the nuclei in upper keratinocytes 
  • Paucity of inflame cells 

36

DD of hairy leukoplakia

  1. Idiopathic leukoplakia 
  2. Frictional keratosis 
  3. Lichen planus 
  4. Hyperplastic candidiasis 

 

37

Hairy tongue clinical appearance and features

  • Asymptomatic hyperplasia of filiform papillae 
  • Thick, matted surface 
  • Gagging or tickling 

38

Etiology of dentrifrice-associated sloughing

  • Superficial chemical burn 
  • Reaction to SLS in tooth paste 

 

39

What is the tissue like underneath dentifrice associated slough? 

Normal under the tissue

40

Clinical features of dentrifrice-associated sloughing

  • Superficial, white sloughing 
  • Painless 
  • Responds after switch toothpaste 

 

41

Actinic cheilitis etiology

Chronic exposure to UV light 

42

Actinic cheilitis clinical features

Color: pale to silver/grey

Appearance:

  • Fissured or glossy
  • Irregular with white diffuse thickening 
  • Superical scaling, cracking, crusting 

Painless and chronic 

43

Treatment actinic cheilitis

Lip protection 

Biopsy if persistent 

  • 10% of cases = malignant SCC

 

44

Location of actinic cheilitis

Lower lip

45

Histopath of actinic cheilitis

1. Epidermis: atrophic and hyperkeratotic 

2. Frequent dysplasia

3. Solar elastosis in the submucosa 

46

Definition of leukoplakia

A white patch which cannot be wiped off or characterized as any other disease 

47

T/F Leukoplakia is always a clinical diagnosis

True. Histo diagnosis will never be leukoplakia 

48

Percentage of malignant transformation and hyperkeratosis to dysplasia in leukoplakia

malignant transformation: 10-15%

hyperkeratosis to dysplasia: 5-25%

49

Etiology of leukoplakia

  • Tobacco and alcohol abuse 
  • C. albicans
  • Nutrition deficiency 

50

Average age of leukoplakia

40 years old 

51

Common locations of leukoplakia

  1. Tongue
  2. Mandibular mucosa
  3. Buccal mucosa 
  4. Floor of mouth 

 

52

Clinical features of leukoplakia 

Appearance

  • Well defined borders
  • Flat slightly raised 
  • Verrucous or wartlike
  • Granular or speckled with red spots 
  • Can be rough or soft and smooth 

53

What is proliferative verrucous leukoplakia?

Multiple irregular white plaques 

It is persistent, multifocal and aggressive with malignant transformation of 80-100%. 

54

DD of leukoplakia

  1. Candidiasis
  2. Frictional keratosis
  3. Lichen planus 
  4. Lupus erythematosus 
  5. Hairy leukoplakia 

55

Histopath of leukoplakia 

  • Hyperkeratosis 
  • Acanthosis 
  • Dysplasia
    1. Teardrop rete ridges 
    2. Basilar hyperplasia
    3. Maturational disturbances 
    4. Dskeratotoci cells 
  • Cellular Changes
    1. Enlarged cells/nuclei 
    2. Hyperchromatism and pleomorphisms 

56

Degrees of Dysplasia in Leukoplakia 

  1. Mild 
    • Basailar 1/3
  2. Moderate
    • Basialr 1/2  
  3. Severe
    • Cell alterations basilar 2/3 of epithemlium
  4. Carcinoma in situ
    • Full thinkness change. No invasion. 

57

Etiology of hairy tongue

  • Antibiotics
  • Oxygenating mouth washes 
  • Intense smoking 

58

Onset of HBID

  • Early onset 
  • Usually in the first year

59

Microscopic appearance percentages of leukoplakia

  • 80% -- hyperkeratosis and acanthosis 
  • 12% -- dysplasia 
  • 3% -- carcinoma in situ
  • 5% -- squamous cell carcinoma 

60

Treatment for Leukoplakia 

  1. STOP smoking or alcohol use 
  2. Biopsy/excision/laser removal 
  3. COX2 inhibitors 

 

61

How long does transformation to malignancy of leukoplakia take?

2-4 years with granular/veruciform being the greatest risk

62

T/F after excision leukopakia is regularly followed up

True

63

Cause of geographic tongue

Unknown

64

Geographic tongue is associated with: 

 

  • Psoriasis
  • Reiter's syndrome
  • Seborrheic dermatitis 

 

65

Another name for geogrpahic tongue

Erythema migrans 

66

Clinical appearance of Geo tongue

  • Artophic patches surrounded by elevated keratotic margins (WHITE MARGINS)
  • Areas move around and change appearance 
  • CAN be associated with fissured tongue

 

67

Symptoms and location of geo tongue

  • USUALLY asymptomatic
  • Occasional complain of burning or tenderness

 

  • Floor of mouth, buccal mucosa, palate 

68

A biopsy is need for geo tongue

False 

69

Histopath of geo tongue

White margins: hyperkeratosis + acanthosis

Center red area: loss of keratin, intraepitheliala neutrophils 

70

Treatment of geo tongue

  1. MAGIC mouthwash
  2. Can use topical steroids 

71

Cause of lichen planus 

Unknown cause. 

Immunologically mediated 

Increase in cytokines in the basement membrane

72

Clinical features of lichen planus

  • Middle aged men and women 
  • Skin and oral lesions 
  • Keratinocytes killed by CD4/8 T cells 

73

What are the P's of lichen planus 

  1. Puritic 
  2. Papular 
  3. Purple 
  4. Plaques 

74

What are the forms of lichen planus

  1. Reticular form 
  2. Plaque 
  3. Erythematous 
  4. Erosive 

75

Describe the reticular and plaque forms of lichen planus

  • Reticular
    • White keratotic lines -- WICKHAM'S STRIAE
    • Lacy pattern 
    • Seen bilaterally on the cheeks. Can be on tongue or gingiva 
  • Plaque
    • Slightly elevated to smooth and flat plaques
    • Resembles leukoplakia 
    • Multiple present 

76

Describe the steps in lichen planus disease mechanism

  1. Initiating event 
  2. Focal release of cytokines 
  3. Upregulation of vascular adhesion molecules 
  4. Recruitment of T cells 
  5. Cytotoxocity of basal keratinocytes mediated by T cells 

77

Important histopath of lichen planus (think of immunologic events)

  • Hyperkeratosis 
  • Degenration of the basal cell layer 
  • Saw tooth rete rides 
  • Dense BAND-LIKE inflammatory infiltrate in subepithelial region

78

Describe the DIF of lichen planus 

Presence of FIBRINOGEN at the basement membrane zone

79

Describe the erythematous and erosive LP forms

  • Erythematous 
    • Red patches with white striae 
    • Attached gingiva commonly involved 
    • Can feelin burning, discomfort 
  • Erosive 
    • Central area is ulcerated
    • Keratotic straie adjacent to erosive site 

80

Name a variant of lichen planus 

  • Bullous lichen planus 
    • Short lived with painful ulcers developing 
    • Usually on buccal mucosa 

81

LP treatment

  • No cure, just control of disease 
  • Topical and systemic corticosteroids 
  • Immunosuppressive medications 
  • Topical tacrolimus

82

Lichen planus is an acute disease 

False 

83

Forms of lupus erythematosus (LE)

  1. Systemic or acute (SLE)
  2. Localized or discoid (DLE) 

84

Etiology of LE 

  • Autoimmune disease involving both humoral and cell-mediated immunity 
  • Antibodies to nuclear antigens (ANA) present in serum and tissue 
  • Also see circulating AN-AB complexes 

 

85

Typical person with DLE

Middle aged women

86

Clinical Features of DLE 

  • Skin
    • Erythematous (red) plaques with hyperpigmented margins 
  • Oral
    • Buccal mucosa, gingiva, vermilion most commonly involved 
    • Erythematous and ulcerative lesions with white straie 

87

Clinical Features of SLE 

  • Other organ systems
    • Joints 
    • Lungs, kidney, heart  
  • Systemic symptoms 
    • Fever, weight loss, feel like poop 
  • Oral
    • Vermilion, buccal mucoasa, gingiva 
    • Erythemayous or ulcerative lesions with white straie 

88

DD of SLE 

  • Lichen planus 
  • When lesions erythemayous 
    • MMP
    • Erosive lichen planus 
    • Erythematous candidiasis
    • Contact hypersensitivity 

89

Histopath of LE 

  • Hyperkeratosis with epithelial atrophy 
  • Basal cell destruction 
  • DIF with linear depositis of IgG, IgM, IgA, C3, and fibrinogen along the basement membrane

90

Treatment of LE 

  • Topical corticosteroids 
  • Systemic steroids 
  • Immunosupresives 
  • Antimalrials 

 

91

Three non-epithelial white lesions studied

  1. Candidiasis
  2. Submucous fibrosis 
  3. Mucosal burns 

92

Candidiasis is an oppurtunistic infection

True

93

Define the acute and chronic types of candidiasis

  • Acute
    • Pseudomemranous 
    • Atrophhic 
    • Erythematous 
  • Chronic 
    • Hyperplastic 
    • Atrophic 
    • Angular cheilitis 

94

Predisposing factors of candidiasis 

  • Dentures 
  • Dry mouth 
  • Diabetes 
  • Antibiotic or steroid use 
  • Immunopsuppresion -- HIV, chemo, organ transplant 

95

Most common type of candidiasis 

Pseudomembranous or thrush

96

Describe pseudomembranous candidiasis 

  • Young and elderly affected 
  • White plaque that wipes off and leaves a red base underneath 

97

Appearance of erythemayous candidiasis

Bright red with a velvet or pebble surface

98

DD of candiiasis 

  • Red
    • Trauma 
    • Drug reaction 
    • Erosive lichen planus 
    • LE 
  • White 
    • Chemical or trauma burn 
    • Mucous patch of syphilous 
    • White keratotoic plaques 

99

 Treatment of candidiasis 

  • Find the cause of it 
  • Antifungal agents 
    • Nystatin 
    • Clotrimazole 

100

Etiology of oral submucous fibrosis (think if India)

  • Chewing betel quid 
    • Causes impaired degeneration of normal collagen 

101

Clinical features of OSF 

  • White/yellow change that has a chronic insidious route 
  • Oral cavity loses its resilience and shows decreased vascularity and elastisity 
  • Mucosal rigidity, pain, trismus 

102

Histopath of OSF 

  • Hyperkeratosis 
  • Atrophy of epithelia
  • Dense collagen deposits 
  • Chronic inflammation 
  • Dysplasia 
  • SCC (6%) 

103

Treatment of OSF

  • Steroids
  • Eliminate the causitive agent 
  • Surgical excision of bands 
  • Close follow up 

104

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