White patch and coloured lesions

Question 1

Name some developmental white patch lesions

Answer 1

white sponge naves

other rare syndromes

Question 2

Name some acquired white patch lesions

Answer 2

Transient – burns, cheek-biting, thrush

Persistent – keratoses, candida in HIV

Lichen planus

Lupus erythematosis

Carcinoma

Question 3

How does white sponge naevus present?

Answer 3

As a bilateral shaggy or spongy white lesion

Buccal mucosa are affected and sometimes tongue

Question 4

What happens in cheek biting?

Answer 4

The damage inflicted is abrasion of superficial epithelium leaving whitish fragments on red
background

Question 5

Where are the lesions located in cheek biting?

Answer 5

On buccal mucosa near occlusal line or lower labial mucosa

Question 6

How do chemical burns occur?

Answer 6

This is common and occurs when chemicals are put in buccal sulcus eg aspirin

To stop habit lesion is self-limiting

Question 7

How do chemical burns appear?

Answer 7

White sloughing lesion of buccal sulcus and mucosa

Question 8

What is another name for candidal infections?

Answer 8

pseudomembranous candidiasis thrush

Question 9

Why do candidal infections occur?

Answer 9

due to disturbed oral microflora by antibiotics, corticosteroids etc

Question 10

What happens in candidal infections?

Answer 10

The white creamy plaques present can be wiped off to leave red base

Question 11

How can we treat candidal infections?

Answer 11

Treat predisposing cause

Topical antifungals

Question 12

How does candidal leukoplakia appear?

Answer 12

Frequently speckled

Affects buccal commissures and lateral borders of tongue

Question 13

What is candidate leukoplakia associated with?

Answer 13

Smoking

May have malignant potential

Question 14

What may candida leukoplakia respond to?

Answer 14

Antifungals and stopping smoking

Question 15

What is leukoplakia?

Answer 15

Is a term used for hyperkeratotic, white mucosal lesions, of unknown cause

These are fairly common

Question 16

Are most leukoplakia white patches of unknown aetiology benign or malignant?

Answer 16

benign

1-3% are premalignant

Question 17

Why do many lesions have to be biopsied?

Answer 17

to test for dysplasia or early malignant change

Question 18

On what site is leukoplakia most frequent?

Answer 18

buccal mucosa

Question 19

What are the 3 different appearances in leukoplakia?

Answer 19

Most smooth plaques (homogenous)

Warty (verrucous leukoplakia)

Mixed white/red (speckled leukoplakia)

Question 20

When do we know in leukoplakia there is potential for malignant change?

Answer 20

Homogenous are usually benign

Speckled has higher malignant potential than verrucous

Question 21

What are the aetiologies of keratosis?

Answer 21

• Idiopathic
• Friction
• Tobacco
  Nicotinic keratosis of palate

Betel chewing and smokeless tobacco – keratosis of buccal sulcus

• Microorganisms, viral and bacterial

Question 22

What are the sites of frictional keratosis?

Answer 22

• Buccal occlusal line
• Beside outstanding tooth
• On edentulous ridges

Clears up when irritation is removed

Question 23

What is the usual cause of smoker’s keratosis?

Answer 23

due to effect of heat and smoke

Question 24

How does smoker’s keratosis appear?

Answer 24

Red spots on white background, as small salivary glands appear through the widespread white patch

Lesion is benign but carcinoma may develop nearby

Question 25

What is snuff dipping and smokeless tobacco associated with?

Answer 25

verrucous keratosis – this can progress to verrucous carcinoma

Question 26

What microorganism can cause white patch lesions?

Answer 26

Candida albicans

Question 27

What are the features of hairy leukoplakia?

Answer 27

Corrugated appearance Affects margin of tongue Seen in HIV infection and immunocompromised Is benign May respond to acyclovir

Question 28

Describe syphilitic leukoplakia

Answer 28

This is a feature of tertiary syphilis Affects dorsum of tongue Is rare Has high malignant potential

Question 29

What is the site of sublingual keratosis?

Answer 29

floor of mouth and ventral surface of tongue

Question 30

What is the aetiology of sublingual keratosis?

Answer 30

unknown

Question 31

What is the malignant potential of sublingual keratosis?

Answer 31

high >20%

Question 32

How can we treat sublingual keratosis?

Answer 32

Can be excised with laser or cryoprobe

Question 33

What is the aetiology of lichen planus?

Answer 33

condition is common there’s usually no aetiological factor identifiable minority of times due to drugs, filling materials etc (lichenoid)

Question 34

What are the symptoms of lichen planus?

Answer 34

sometimes asymptomatic other times white striated lesions are common, erosions are less common

Question 35

What are the common sites of lichen planus?

Answer 35

- Buccal mucosa - Tongue - Gingival margins – can cause desquamative gingivitis skin lesions may also be present

Question 36

Is the malignant potential in lichen planus small or high?

Answer 36

small

Question 37

How may keratinising carcinomas arise?

Answer 37

as oral white lesions and may also arise in other white oral lesions

Question 38

Where are 70% of oral cancers found?

Answer 38

- Lower lip - Lateral borders of tongue - Floor of mouth

Question 39

How do oral cancers present?

Answer 39

- Oral ulcer - Red patch - White patch - Red and white patch - Swelling - Atrophic area

Question 40

Name some developmental coloured lesions

Answer 40

Pigmented naevi Racial pigmentation Peutz-jeghers syndrome Sturge-weber syndrome

Question 41

Name some acquired coloured lesions

Answer 41

Infective Latrogenic Malignant/pre-malignant Other

Question 42

How do pigmented naevi present?

Answer 42

brownish or blue macules usually <1cm diameter

Question 43

How do we treat pigmented naevi?

Answer 43

Excisional biopsy to exclude malignant melanoma

Question 44

What is peutz-jeghers syndrome?

Answer 44

multiple peri-oral pigmented macules present on lips and buccal mucosa

Question 45

How do we treat peutz-jeghers syndrome?

Answer 45

None required after confirmed diagnosis

Question 46

How does racial pigmentation appear?

Answer 46

brown pigmentation of gingiva or tongue

Question 47

How to treat racial pigmentation?

Answer 47

May need to exclude other causes of pigmentation

Question 48

What is sturge-weber syndrome?

Answer 48

congenital angioma in the trigeminal region there is a haemangioma in the trigeminal region of face, oral mucosa and underlying bone

Question 49

What should we avoid when there is a haemangioma?

Answer 49

Extractions as haemangiomas involve underlying bone

Question 50

What are the causes of candidosis?

Answer 50

- Usually C.albicans - Constant denture-wearing - Poor denture hygiene - High carbohydrate diet

Question 51

How do we treat candidosis?

Answer 51

- Improved denture hygiene - Antifungals - Leave denture out

Question 52

What is erythematous candidosis associated with?

Answer 52

- Appearance of red sore mouth - With xerostomia or broad spectrum antibiotics - May be a feature of immunosuppression eg HIV

Question 53

How do amalgam tattoos appear?

Answer 53

black or bluish-black in a solitary small pigmented area radiopaque

Question 54

How do amalgam tattoos occur?

Answer 54

amalgam particles incorporate in healing wounds after extraction or in other surgery

Question 55

Why is a biopsy required in amalgam tattoos?

Answer 55

To distinguish from melanoma or naevus

Question 56

What 3 drugs cause pigmentation?

Answer 56

Adrenocorticotrophic hormone causes pigmentation Heavy metals eg lead cause pigmented lines in the gingiva Antimalarials and others can cause coloured lesions

Question 57

What is a haemangioma?

Answer 57

hamartoma or benign tumour of vascular tissue

Question 58

How do haemangiomas appear?

Answer 58

red or blue with painless soft swelling – they usually blanch on pressure

Question 59

Where is it most common to find a haemangioma?

Answer 59

- Lip - Tongue - Buccal mucosa

Question 60

How do we treat a haemangioma?

Answer 60

Observe if not symptomatic, otherwise cryosurgery, laser or embolization

Question 61

How common are erythroplasias?

Answer 61

more uncommon and are mainly seen in elderly males less common than leukoplakias

Question 62

How do erythroplasias appear?

Answer 62

red velvety patch

Question 63

Why is a biopsy required in erythroplasias?

Answer 63

these are more likely to be dysplastic or malignant To distinguish from other atrophic lesions eg anaemias, lichen planus, geographic tongue >90% are either dysplastic or carcinoma is present

Question 64

Where do malignant melanomas often affect?

Answer 64

palate

Question 65

How do malignant melanomas appear?

Answer 65

heavily pigmented

Question 66

How common are malignant melanomas?

Answer 66

rare intraorally compared to skin lesions

Question 67

How do we treat malignant melanoma?

Answer 67

With a wide excision but poor prognosis if not treated early

Question 68

What colours are karposi's sarcoma?

Answer 68

- Red - Purple - Brown macules

Question 69

Where do karposi's sarcoma usually affect?

Answer 69

- Palate - Maxillary gingiva

Question 70

What type of infection are karposi's sarcoma usually seen as?

Answer 70

a HIV infection that form due to the malignant neoplasm of endothelial cells