White Lesions: Preneoplastic & Neoplastic Lesions

Question 1

Preneoplastic & Neoplastic Lesions

Answer 1

a. Actinic Cheilitis
b. Actinic Keratoses
c. Idiopathic Leukoplakia

Question 2

accelerated tissue degeneration of the vermilion (dry mucous membrane) of the lips,
especially the lower lip, as a result of chronic exposure to sunlight;

it is considered to represent a potentially premalignant condition

Answer 2

Actinic Cheilitis

Question 3

Overexposure to ultraviolet light (esp. UVB [2900-3200 nm]

Answer 3

Actinic Cheilitis

Question 4

Lower lip affected because of exposure to sun; upper lip usually
with minimal change
More severe in light-skinned individuals
Atrophic, finely wrinkled, and often swollen appearance of lip
Possible presence of white and/or pigmented foci
Poorly defined vermilion–skin junction
Possible chronic ulceration in more severely damaged lips

Answer 4

Actinic Cheilitis

Question 5

Avoidance of direct sunlight
Use of sunscreen/sun-blocking agent
Biopsy of persistent ulcers and indurated lesions
Vermilionectomy possibly needed in problematic cases
Wedge excision of suspicious lesion is an alternative

Answer 5

Actinic Cheilitis

Question 6

the cutaneous counterpart of actinic cheilitis, are epithelial changes noted typically in light-complexioned individuals who have had long-term exposure to sunlight.

Answer 6

Actinic Keratoses

Question 7

• Oval plaques, usually smaller than 1 cm in diameter, are typically found on the forehead, cheeks, temples, ears, and lateral portions of the neck.
• Color may vary from yellow-brown to red, and the texture is usually rough and sandpaper-like.

Answer 7

Actinic Keratoses

Question 8

• Avoidance of direct sunlight
• Use of sunscreen/sun-blocking agent
• Lip protection is indicated.
• The use of lip balm containing a sunscreen agent, or its derivatives, is indicated during periods of sun exposure in high-risk patients.
• Biopsy of persistent ulcers and indurated lesions
• Wedge excision of suspicious lesion is an alternative
• Laser

Answer 8

Actinic Keratoses

Question 9

a white patch or plaque of oral mucosa that cannot be rubbed off and cannot be characterized clinically as any other disease.

Answer 9

Idiopathic Leukoplakia

Question 10

may range microscopically from benign hyperkeratosis to invasive squamous cell carcinoma, a biopsy is mandatory to establish a definitive diagnosis

Answer 10

Idiopathic Leukoplakia

Question 11

Risk Factors: Tobacco, alcohol, C. albicans infection, nutrition, unknown

Answer 11

Idiopathic Leukoplakia

Question 12

condition associated with middle-aged and
older populations.

A vast majority of cases occur after the age
of 40 years.

Answer 12

Idiopathic Leukoplakia

Question 13

On visual exam, may vary from a barely evident, vague whiteness on a base of uninflamed, normal-appearing tissue to a definitive white, thickened, leathery, fissured, verrucous (wartlike) lesion

Answer 13

Idiopathic Leukoplakia

Question 14

Red zones may also be seen in some leukoplakias, prompting use of the term _______________ (erythroleukoplakia).

Risk of malignant transformation of speckled leukoplakia is greater than lesions that are homogeneous.

Answer 14

speckled leukoplakia

Question 15

On palpation, lesions
may be soft, smooth, or finely granular. Other lesions may be roughened, nodular, or indurated.

Answer 15

Idiopathic Leukoplakia

Question 16

cause is unknown, although early reports suggest a relationship in some lesions with human papillomavirus (HPV)

Answer 16

Proliferative verrucous leukoplakia

Question 17

This type of leukoplakia, often on the gingiva, begins as simple keratosis and eventually becomes verrucous in nature.

Lesions tend to be persistent, multifocal, recurrent, and
sometimes locally infiltrative

Answer 17

Proliferative verrucous leukoplakia (PVL)

Question 18

Histologic changes range from hyperkeratosis, dysplasia, and carcinoma in situ to invasive squamous cell carcinoma

Answer 18

Idiopathic Leukoplakia

Question 19

If the lesion in question is not removable and is not
clinically diagnostic, it should be considered an ______________ and a biopsy should be performed.

Answer 19

idiopathic leukoplakia

Question 20

• Surgical excision is preferred for the treatment which may lead to examining the lesion histologically

Answer 20

idiopathic leukoplakia