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Flashcards in Oral Lesions + SSC Deck (65):
1

Aphthous Stomatitis : population

25%
Females
Congenital

2

Aphthous Stomatitis : pathogenesis

UNCLEAR
Immunodeficiency
Decrease of mucosal barrier
Genetic
Antigenic exposure

3

Aphthous Stomatitis :

Associated conditions

Inflammatory Bowel Disease (chrohn's)
Celiac disease
Betchet's Syndrome (eye, genital)
SMOKING LOWERS

4

Aphthous Stomatitis:

Patho

Recurring, SUPER painful solitary/multiple ulcer
White-yellow pseudomembrane

5

Aphthous Stomatitis:

Variants?

Minor
Major
Herpetiform

6

Minor Aphthous Stomatitis:

Path

Well-circumscribed, superficial
<1cm
Labial / buccal mucosa, ventral tongue

7

Minor Aphthous Stomatitis:

Duration

10-14 days
No scarring
1-3 episodes/year

8

Major Aphthous Stomatitis:

Path

Onset after puberty
Lesions - larger,deeper, more
Tongue, soft palate, tonsillar fauces

9

Major Aphthous Stomatitis:

Duration

2-6 weeks
Heals w/ scarring

10

Herpetiform Aphthous Stomatitis:

Path

Onset - adulthood
Many lesions + recurrences
Small (1-3mm), coalesce
Any oral surface

11

Herpetiform Aphthous Stomatitis:

Duration

7-10 days

12

Aphthous Stomatitis :

DX

history, PE
Should resolve in 2 weeks, if no, biopsy

13

Aphthous Stomatitis:

Tx

SYMPTOMATIC
Corticosteroids
*Fluocinonide gel
*Clobetasol propionate gel
*Triamcinolone acetonide

Chlorhexidine Gluconate (peridex) mouthwash
Amelexanox Paste (Aphthasol)

14

Aphthous Stomatitis:

pain relief

Viscous lidocaine
OTC Benzacaine (oragel, anbesol)
MOM antacid + diphenhydramine swish

Possible prednisone

15

Oral Herpes Simplex :

Etiology

15-45%
Primary infection in childhood
Most common site 2ndry Infxn - vermillion border/ perioral area (herpes labialis)

16

Acute Herpetic Gingiosomatitis:

Etiology

6 mos - 5 years
Peak 2-3 years old

Maternal antibodies younger than 6 mos

17

Acute Herpetic Gingivostomatitis:

Presentation

Abrubt onset
Cervical lymph
High fever
Chills, nausea, anorexia
Irritability

18

Acute Herpetic Gingivostomatitis:

Path

Lesion - vermillion border/lips to perioral area
Pinhead vesicles --> central ulcerations, erythema
Enlarged angry gingiva

19

Acute Herpetic Gingivostomatitis:

Adult presentation

Pharyngotonsillitis
(Vesicle - tonsil, post. Pharynx)
Resolve in 1-2 weeks

20

Oral Herpes Simplex:

Secondary/Recurrent Infection Triggers

UV, Trauma, Stress, Pregger

21

Herpes Labialis:

Path

6-24 hour prodrome
Rupture/Crust 1-2 days
Heal 7 - 10 days

22

Herpes Labialis:

Dx

History + P.E.
Viral culture
PCR
Serology - 4-8 days
Chronic? biopsy

23

Tzank prep

Herpes (multinucleated epithelial)

24

Varicella

Differential signs

Itching
All lesion phases

25

Herpes Zoster:

differential signs

Dermatome on 1 side
Older

26

Mononucleosis:

Differential signs

posterior tonsil exudate

27

Hand-and-Foot
(Coxsackie)

differential signs

Hands and feet
Younger

28

Herpes simplex:

Tx

SUPPORTIVE
Viscous lidocaine
NSAID
Acyclovir (Zovirax)
Valacyclovir (Valtrex), Famciclovir (Famvir)
1st infxn: acyc, valacy
2nd infxn: famcic, acyc
Penciclovir cream

29

Oral Lichen Planus:

Dx. 5 Ps

Purple
Pleuritic
Planar
Papular
Plaque-like

30

If have Lichen planus, you should screen for

Hep C

31

Oral Lichen Planus:

Etiology

Women
30-60 y/o

32

Oral Lichen Planus:

Presentation

LESIONS - Multiple, bilateral, symmetrical
LOCATION - buccal mucosa, gingiva, tongue dorsum, labial mucosa, lower vermillion
Koebner Phenomenon

33

Oral Lichen Planus :

Presentation types

Reticular - white
Erythematous - Atrophic/ulcer
Erosive - bullous, ulcerated

34

Oral Lichen Planus:

Reticular lesions

Wickman's Striae
Asymptomatic

35

Oral lichen planus :

Erythematous

Wickman's Straie
Mucosal atrophy - red patch

36

Oral lichen planus:

Erosive

Desquamative gingivitis, frank ulcers, erosions
Bullae - easily rupture

37

Differential - white oral lesions

Candidiasis, leukoplakia, secondary syphilis, discoid lupus

38

Differential - Erythematous/Ulcerative lesions

Aphthous ulcers
Discoid lupus
Erythema multiforme
Primary HSV stomatitis
Oral SCC

39

Oral Lichen Planus:

Dx

Hx + PE
Bilateral whitman's straie (one side- biopsy gingiva)

40

Oral Lichen Planus:

Tx

No cure
Oral hygiene
No tobacco/alcohol
1st line - topical corticosteroid
*Clobetasol proprionate
*Betamethasone proprionate

41

Oral Lichen Planus :

prognosis

Chronic, variable
No spontaneous remission
Post-inflame hyperpigmentation
Possible turn to SCC (6mos monitor)

42

Oral Lichenoid Drug Reacions (OLDR)

Less common than cutaneous
Adults
UNILATERAL
NAKS
(nsaids, ACEI, Ketoconazole, Sulfonylureas)

43

Leukoplakia :

Presentation

White patch, doesn't scrape
Lip vermillion, buccal mucosa, gingiva
Early lesions - exophitic, gray/white
Homogenous/heterogeneous

44

Leukoplakia:

cancer?

Slower transform to SCC
Ventral tongue, oral floor
Female, non-smoker
5-25% - epithelial dysplasia

45

Leukoplakia:

Dx

Biopsy
Hyperkeratosis, acanthosis

46

Leukoplakia :

Tx

No dysplasia - monitor every 6 mos.
Moderate dysplasia - excision

47

Proliferative Verrucous Leukoplakia

DO NOT MISS DX
Female
Keratotic plaques, rough surface projection
60% to SCC w/in 7 yrs

48

Erythroplakia:

Etiology

Age 65-74

49

Erythroplakia:

Path

Mouth floor, ventral tongue, soft palate
Multiple lesions
Well-demarcated, red, asymptomatic, macule/plaque, soft velvety (no keratin)

50

Erythroplakia :

Dx

Biopsy

51

Erythroplakia :

Tx

Guide by degree of dysplasia
MODERATE - full excision
Follow-up : recurrence

52

Oral SCC :

Etiology

90% oral cancer
Male, >40, AA.
Tobacco use + heavy ETOH
UV/radiation, phenolic, Betal, Plummer Vinson, Vit A, 3 syphilis, HPV, immune

53

Oral SCC:

Path

Tongue, mouth floor, vermilion lip border

54

Oral cavity

Lips
Buccal mucosa
Front 2/3 of tongue
Teeth
Floor of mouth
Hard palate
Retro molar area

55

Oropharynx

Back 1/3 tongue
Soft palate
Tonsils+pillars
Throat Back wall

56

Oral SCC warning sign

LESION 2 WEEKS +
Pain, lump, ear pain, bleeding, bad breath

57

Lip Vermillion Carcinoma:

Etiology

Light-skin, sun

58

Lip Vermillion Carcinoma

Lower lip
Crusted, nontender, oozing w/ ulcer
<1cm
Slow grower, late meta
Submental nodes

59

Intraoral SCC :

Where

Tongue - post. Lat, ventral
Oral floor- from leuko/erythroplakia
Gingival - bone, tobacco, female
Posterior - advanced lesion

60

Intraoral SCC :

Presentation (lesions)

Most NO PAIN
Leuko/erythro/erythroleukoplakia
Exophytic/endophytic
Bone - moth bite, radiolucent

61

Intraoral SCC :

Dx

Biopsy
Scope 2nd cancer - larynx, lung, esophagus
Head/Neck - CT
Chest - CT/x-ray

62

Intraoral SCC :

Metastases

Ipsilateral cervical node
Oral floor --> submental
Lung, liver, bone

63

Carcinoma staging

TNM

T : tumor size (I, II, III, IV)
N: node
M: metastases

64

Intraoral SCC:

Tx

Guided by stage
Excision, radiation, chemo/radio

65

Intraoral SCC :

Prognosis

1/2 die w/in 5 yrs (BAD)
Survive 1st cancer - 20x for next
Early Dx + prevention