Lesions & Lifestyles attended a 3 hour Continuing Education Seminar on Oral Pathology presented by Nancy Dewhirst, RDH,BS on (date) at (location):. Course material is directly related patient care. Notes: 1. Oral pathology risk 2. Early detection 3. Early signs of Oral Cancer a. Sore, irritation, lump or thickening b. White or red patch c. Difficulty in chewing or swallowing d. Ear pain e. Difficulty moving the tongue or jaw f. Hoarseness, sore throat g. Feeling that something is caught in the throat h. Numbness (tongue or other areas) i. Swelling of the jaw that causes dentures to fit poorly or become uncomfortable j. Small white lesions k. Small red velvety lesions l. Combination red and white lesions m. Indurated nodules or masses n. Ulcers that do not heal or that persist for longer than 2 weeks o. Extraction site that doesn t heal 4. Oral CA Risk Factors a. CA history b. Radiation therapy c. Leukoplakia d. Erythroplakia e. Non-healing ulcer f. Swelling, numbness, tingling g. Difficulty swallowing, chewing h. Sore throat, hoarseness i. Non-painful enlargement j. Lichen planus k. Tobacco l. Alcohol m. Betel nut, quid, areca nut n. Immune suppression o. Sunburns
p. Poor nutrition q. HPV r. > 50 5. Charting 6. 7. Terms: a. Macule b. Patch c. Corrugated, fissured d. Denuded, circumscribed e. Papillary f. Indurated (firm) g. Well circumscribed: distinct borders
h. Poorly circumscribed: diffuse borders i. Nodule j. Papule k. Lobule i. Unilobular, mutilobular l. Locule i. Unilocular, multilocular m. Exophytic n. Endophytic o. Sessile p. Pedunculated q. Firmly attached, loosely attached r. Movable, fixed s. Density t. Vesicle, Bulla u. Firm, thickened, hard, soft, fluctuant, friable 8. Herpes 9. Aphthous 10. Lips a. Solar cheilitis b. Actinic cheilitis c. Angular cheilitis 11. Basal cell carcinoma 12. Melanoma 13. Intraoral exam 14. Neoplasia: new growth ; uncontrolled and unlimited proliferation of cells that is irreversible 15. Neoplastic cells: a. Pleomorphic b. Hyperchromatic c. Mitotic figures 16. Neoplasms a. SCC = most common oral cancer b. Skin reacts normally to use & trauma with: i. Hyperplasia ii. Keratinization iii. Melanin
c. Neoplastic cells are permanently altered & exhibit extreme presentations of the same features 17. Light fluorescence technology reveals heavy molecules (these look dark): a. Dysplasia (chromatin) b. Melanin c. Blood (hemoglobin) i. Vessels ii. Inflammation iii. Blanching reveals vascularization 18. Treatment Code for Oral CA screening 2431 19. Equipment procedure code (VelScope, Identify) = 4403 White Lesions a. Differential Diagnosis: i. Variant of normal ii. Hyperkeratosis iii. Ulceration / pseudomembrane iv. Fungal infection v. Inclusion 20. Fungal infections: Usually a sign of underlying immunodeficiency a. Candidiasis = Overgrowth of Candida albicans ~ otherwise part of normal oral flora b. Etiology i. Antibiotic therapy ii. Cancer chemotherapy iii. Corticosteroid therapy iv. Infancy v. HIV infection vi. Primary T-lymphocyte deficiency vii. Hypoparathyroidism viii. Multiple myeloma ix. Xerostomia x. Dentures xi. Diabetes mellitus c. Psuedomembranous candidiasis d. Erythematous candidiasis e. Papillary hyperplasia, denture stomatitis, chronic atrophic candidiasis f. Chronic hyperplastic candidiasis g. Angular cheilitis
h. Chronic mucocutaneous candidiasis i. Treatment for Candidiasis i. Topical 1. Clotrimazole (Mycelex) 2. Nystatin (Mycostatin) ii. Systemic 1. Ketoconazole (Nizoral) 2. Fluconazole (Diflucan) 21. Leukoplakia is: 22. Tobacco pouch keratosis 23. Lichen Planus a. Reticular b. Plaque-like c. Erosive high risk for CA 24. Squamous Cell Carcinoma (SCC) a. Malignant tumor of squamous epithelium; usually exophytic ulcerative mass b. Most common oral malignancy c. Can metastasize lymph nodes of the neck, lungs, and liver 25. Proliferative verrucous leukoplakia 26. Verrucous carcinoma 27. HIV oral pathology a. Candidiasis b. Hairy leukoplakia c. Kaposi sarcoma d. Linear erythematous gingivitis (or periodontitis) 28. Betel nut chewing 29. Oral submucous fibrosis 30. Identify & VelScope imaging: reveal best areas to biopsy 31. Brush biopsy limited 32. Punch biopsy 33. Incisional biopsy
34. Excisional biopsy 35. Toluidine blue vital staining HPV related lesions a. >150 types b. Infects epithelium (> 40 found orally) c. Species-specific (infects rabbits, cattle, cats) d. May be associated w/ CA of mouth, tongue, tonsils, throat e. HPV = separate CA risk from tobacco, alcohol f. Kiolocytes = HPV infected cells g. Different HPV types: i. Specific HPV types cause different lesions & have varied CA potential ii. Low Risk: 1. Type 6 & 11: assoc. w/ benign warts: 2. Papilloma 3. Verruca vulgaris 4. Condyloma acuminatum 5. Multifocal epi. Hyperplasia (Heck) iii. High risk: 1. HPV 16, 18, 31, 45 = cause flat, non or hardly visible dysplastic lesions 2. 16 & 18 = cause ~95% of cervical CA, now assoc. with oral / pharyngeal CA 3. Viral particles ID d by immunologic staining iv. Squamous papilloma 1. Most common epi papillary lesion 2. Assoc. w/ HPV 6,11,16 3. Often solitary 4. Asymptomatic v. Verruca vulgaris (common hand wart) vi. Condyloma acuminatum vii. Focal epithelial hyperplasia (Heck) 1. Multiple white to pale-pink nodules throughout the oral cavity 2. Most common in children 3. Diagnosis ~ clinical and microscopic 4. Treatment ~ none viii. Testing for HPV is recommended for: 1. Traditional risks : 2. tobacco users 3. Alcohol drinkers 4. Betel nut users
5. Sexually active (males & females) 6. Family history of cancer 7. How? OralDNA test 8. (+) test ID s HPV & risk, not cancer Questions 1. A lesion with a broad base is called: a. Indurated b. Pedunculated c. Sessile 2. Identify the correct statement about a macule: a. A macule is a pigmented lesion b. A macule is a flat dark lesion c. A macule is a flat lesion of a different color than surrounding tissue 3. A fungal infection that appears white and wipes off, revealing raw red tissue is most likely called: a. Chronic hyperplastic candidiasis b. Denture stomatitis c. Pseudomembranous candidiasis 4. If candidiasis is suspected, a reasonable diagnostic method is: a. Treat with oral antifungal medication and observe for improvement b. Treat with biopsy c. Treat with antibiotics 5. Identify the malignant pathology that is extremely rare intraorally, but common extraorally, and is NOT known to metastasize: a. Squamous cell carcinoma b. Adenocarcinoma c. Basal cell carcinoma 6. Identify the most common intraoral cancer: a. Adenocarcinoma b. Squamous cell carcinoma c. Condyloma acuminatum 7. Neoplastic cells exhibit which microscopic features? a. Hyperchromatic mitochondria, atrophy, thickened cell walls b. Pleomorphic nuclei, hyperchromatic nuclei, increased mitotic figures c. Pleomorphic mitochondria, thickened mitotic figures 8. The best definition of neoplasia is: a. Atypical tissue b. Enlarged tissue c. Uncontrolled and unlimited proliferation of cells that is irreversible
Answers: 1. C 2. C 3. C 4. A 5. C 6. B 7. B 8. C 9. C 10. B 9. Tobacco use and excess alcohol use are considered risk factors for oral cancer. Identify the factor below that is a separate risk for oral cancer. a. Syphilis b. Being female c. HPV infection 10. HPV infection is linked most strongly to which pathology? a. Herpes simplex b. Oral-pharyngeal cancer c. Palatal cancer