what is the most common malignant tumour to arise in the oral cavity?
squamous cell carcinoma
what are most OSCC not accompanied by?
recognised pre exciting mucosal lesions
> some mucosal lesions seem to show an increased association with subsequent OSCC than others, but inconsistent
what does potentially malignant mean?
the lesions are not “malignant” already and it is not inevitable that the OSCC will develop, there is a risk that tumour could arise, although that risk is difficult to evaluate for individual patients
what do PMOL generally look like?
> generally white, red or both
flat, nodular, warty or elevated
large or small
single or multiple
any site but lateral/ ventral of tongue, FOM
what are examples of white / red lesions which aren’t PMOL?
> inherited = white sponge naevus
irritational = frictional keratosis
immunological = LP/LR, LE, others
infective = caused by candida, Epstein-barr virus
iatrogenic = scars, skin grafts and flaps
idiopathic = leukoplakia
classification and definition of leukoplakia?
- homogenous = flat, possibly fissured
- non-homogenous = nodular, speckled or both
proliferative verrucous leukoplakia is believed to be a subset of non homogeneous leukoplakia
def - a white patch which cannot be classified as any other disease and is associated with an increased risk of malignancy
in other words - not = acute candidiasis, frictional keratosis, LP/LR, WSN
definition of erythroplakia?
- a white/red patch that can’t be diagnosed as anything else
- similar to leukoplakia but refers to a red patch
- sometimes called erythroplasia
- diagnosis is based on exclusion and thus needs properly assessed
what intra oral disease have an association with OSCC?
- OLP/ LR
- LE
- patterson Kelly brown syndrome
- submucous fibrosis
- dyskeratosis congenita
- epidermolysis bullosa
what risk is a homogenous leukoplakia in developing into a OSCC?
low risk
what risk is a non homogenous leukoplakia at developing into an OSCC?
high risk
what risk is an erythroplakia at developing into an OSCC?
highest risk
what is the epidemiology of an OSCC?
- variable and complicated
- much uncerctaintity in diagnosis
- rare
- middle age and elderly
- twice as common in males as females
- developing countries = lots of tobacco use = Lots of OSCC = lots of precursors
- less than 10 a year in NI
what are the common sites of OSCC?
- VT
- LT
- FOM
- RMP
what is the size of an OSCC?
- larger
- spanning multiple intraoral sites
what is the appearance of an OSCC?
non-homogenous
microscopic = dysplasia
when would you be more worried if someone had an OSCC?
- in non smokers (absence of risk factors)
what 3 things do you need to do to establish a diagnosis of an unknown lesion?
- history (duration, onset, habits, systemic disease?, medication, family history)
- examination
- special investigations
what do you have to note during an examination of a PMOL?
- the nature
- the size
- the site
- the extent
- that it isn’t anything else
- homo or non-homogenous
why is it important to palpate a PMOL?
to check for any change in the feel of the underlying, especially induration
what laboratory investigation do you complete for a PMOL?
- MICROBIOLOGICAL - candida isolation
- HAEMATOLOGICAL - haematinic deficiencies/ anaemia, biochemistry, autoantibodies
- HISTOPATHOLOGICAL - morphological
what makes a lesion white?
- thicker keratin (hyperkeratosis)
- thicker epithelium (hyperplasia)
- fibrosis in the lamina propia
what makes a lesion red?
- thinner keratin
- thinner epithelium (atrophy)
- vascularity in the lamina propia
what morphological changes may occur in a PMOL?
- hyperkeratosis
- epithelial thickness change
- change in rete peg architecture
- status of basal layer (hyperplasia, apoptosis)
- dysplasia
- changers in lamina propia
- candida present
what is dysplasia?
> a description of architectural and cytological changes in epithelium that resemble those of cancer but without invasion of the tissues
> a form of “intermediate step” in cancer development : a tissue disturbance that looks like a cancer but does not behave like a cancer
> the presence of dysplasia implies some disturbance of epithelial proliferation and/ or differentiation, its presence can assist in treatment
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white and red patches20
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suspicious oro-mucosal lesions12
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lichen planus and lichenoid reactions27
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OSCC18
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PMOL38
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warts, polyps, epulides and vascular anomalies45
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viral infections60
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bacterial infections52
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candidal infections44
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cysts and other non neoplastic diseases of salivary glands32
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salivary gland Hypofunction and Xerostomia35
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Sjogrens Syndrome28
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salivary gland neoplasia50
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salivary gland infections?41
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introduction to facial pain4
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burning mouth syndrome24
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trigeminal neuralgia and facial pain59
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TMD37
