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Epithelial Tumors
Epithelial Tumors
56
Pathology
Post-Graduate
04/05/2013

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Cards

Term
What can epithelial tumors in the oral cavity be derived from? (3)
Definition
1) squamous epithelium
2) salivary gland epithelium
3) odontogenic epithelium
Term
Are benign or malignant epithelial tumors more common?
Definition
benign
Term
Are most epithelial tumors exophytic or endophytic? What is the surface like? Color?
Definition
-exophytic
-ulcerated, indurated, papillary
-red, white, speckled
Term
What are some examples of benign tumors?
Definition
–Papilloma
–Keratoacanthoma
–Melanocyticnevi
Term
What are some examples of premalignant tumors?
Definition
–Leukoplakia
–Erythroplakia
–Actinic keratosis
Term
What are some examples of malignant tumors?
Definition
–Basal cell carcinoma
–Verrucouscarcinoma
–Squamouscell carcinoma
–Malignant Melanoma
Term
What is a papilloma? What does it look like?
Definition
-An exophytic papillary lesion, usually less than 1 cm
-May be sessile or pedunculated, white or pink
Term
papilloma- Where does it appear? What is the cause? Treatment?
Definition
-Can appear on the soft palate, uvula, tongue, gingiva, or buccal mucosa

-Cause is unclear, HPV causes many papillary growths but not all

-Treatment –surgical excision of the base and small area of surrounding normal tissue
Term
How many types of HPV viruses are there? Which cause papilloma? Normal warts?
Definition
-over 100 types
-6 and 11 cause papilloma and gential warts
-2 and 4 cause common warts
-
Term
Which HPVs have been associated with neoplastic lesions and 95% of cervical and anogenital cancers?
Definition
16, 18, 31
Term
What is Keratoacanthoma?
Definition
Endophyticlesion, sharply circumscribed, with a central keratin plug or keratin-filled crater
Term
How long does it take a Keratoacanthoma to develop? What happens to it? How big does it get?
Definition
-Develops rapidly over a period of 1-2 months, frequently regresses spontaneously
-can get up to 2-2.5 CM
Term
Where do Keratoacanthoma commonly develop? In who?
Definition
-Occur on sun-exposed skin of the face, lip being a common area
-Most seen in those over 50
Term
What does Acanthosis mean?
Definition
a increase in stratum spinosumlayer
Term
What is a Melanocytic Nevi? What is it commonly called?
Definition

-A pigmented lesion, may be exophytic, collection of melanocytes
-Commonly called a “mole”
Term
WHat is the difference between a melanocytic nevi and a melanotic macule?
Definition
Melanotic Macule is caused by increased production of melanin granules, other is just a collection
Term
What is a melanotic macule commonly called?
Definition
freckle
Term
What is a leukoplakia? Is it malignant?
Definition
white plaque that cannot be wiped off, pre-malignant
Term
What COULD a leukoplakia be? (4)
Definition
-hyperkeratosis
-hyperplasia
-dysplasia
-squamous cell carcinoma
Term
How many % of leukoplakia show dysplasia?
Definition
5-25%
Term
WHat is the treatment for a leukoplakia?
Definition
try to find out cause, if does not resolve take biopsy, any dysplasia or in high risk areas should be removed
Term
What are some areas that are considered to be "high risk"?
Definition
-sides of tongue
-floor/sides of tongue
-retromolar pad
-tonsillar area
Term
What is a leukoedema? Are these pre-malignant?
Definition
-A translucent, grayish-white, film involving the buccal mucosa
-A variant of normal, NOT pre-malignant
Term
Where are leukoedema found? What happens when they are stretched?
Definition
-found bilaterally
-disappear when stretched
Term
Who are leukoedema found in?
Definition
-85-95% black
-40-45% white
Term
Why are leukoedema called that? What is the treatment?
Definition
-Called Leukoedema because fluid accumulates within the spinous cell layer of the epithelium
-no treatment
Term
What is a Eythroplakia? Is it as common as a leukoplakia?
Definition
-clinical term to describe lesion that is smooth red patch or velvety patch
-not as common as leukoplakia but 90% of erythroplakia are dysplasia or squamous cell carcinoma
Term
What must be performed on a leukoplakia? What is it called if it is red and white mixed?
Definition
-biopsy
-called a speckled leukoplakia
Term
What is Actinic (solar) Cheilitis?
Definition
Pre-neoplasticchanges seen in the epithelium of the lips in response to prolonged sun exposure
Term
What does Actinic (solar) Cheilitis look like? Where does it commonly form?
Definition
-Vermilion border becomes fuzzy often with a puffy, rounded margin
-Vermilion zone becomes mottled with red and white patches
-Chronic ulcers frequently develop, that eventually stop healing
Term
What is the most common type of precancerous lesion?
Definition
Actinic keratosis
Term
What does Actinic keratosis look like? Where is it found? What causes it?
Definition
-Appear as scaly, crusty patches
-Most common locations are the back of the hands, cheek, forehead, ear, and lower lip
-Caused by long-term sun exposure
Term
What is Basal Cell Carcinoma?
Definition
A malignant tumor of hair-bearing areas of the skin –does not arise on mucous membranes
Term
Where is basal cell carcinoma commonly found? How does it start? Does it generally metastasize?
Definition
-Most common areas are the sun-exposed areas of the face and ears
-Starts as a papule, enlarges and develops into a crusted ulcer with a rolled border
-Rarely metastasizes
Term
What is the treatment and cure rate for basal cell carcinoma?
Definition
-Treatment –surgical removal, electrocautery
-Cure rate –95%
Term
What is Verrucous Carcinoma? How does it grow?
Definition
-Exophytic, highly keratinized, warty, well-differentiated, superficial
-Grows slowly, unlikely to metastasize
Term
What is common with Verrucous Carcinoma? Who is it seen in? Treatment?
Definition
-Regional lymph nodes often tender (inflammatory in nature)
-Seen in high percentage of tobacco users
-Treatment –surgical excision or laser therapy –good prognosis
Term
What is the most common malignancy in the oral cavity, accounting for90% of all oral cancers?
Definition
Squamous Cell Carcinoma
Term
When is squamous cell carcinoma seen? What are some risk factors for it?
Definition
-Often the end stage of alterations seen as solar cheilitis or dysplasia
-Risk factors: age, tobacco use, alcohol consumption, viruses, sun exposure, nutritional deficiencies, chronic irritation
Term
Where are the top 6 places squamous cell carcinoma is commonly found? (most common to least common)
Definition
1.lower lip
2.lateral/ventral tongue
3.floor of mouth
4.soft palate
5.gingival/alveolar ridge
6.buccal mucosa
Term
What do early squamous cell carcinoma lesions present as?
Definition
leukoplakias and erythroplakias
Term
What may squamous cell carcinoma look like?
Definition
-painless ulcer, an exophytic mass, or a papillary growth
-If infiltrated deep, may appear as a firm, indurated area with loss of tissue mobility
Term
Do squamous cell carcinoma's metastasize? How?
Definition
yes, Invasion into connective tissue allows neoplastic cells to enter the blood vessels and lymphatic system and metastasize to distant sites
Term
What does the prognosis of squamous cell carcinomas depend on?
Definition
the location of the lesion
Term
Which locations of squamous cell carcinomas are dangerous? Which are not?
Definition
-lower lip- good prognosis
-tongue and intraoral sites not as good, lesion in dangrous areas have <30% prognosis
Term
What is a Malignant Melanoma?
Definition
Neoplasm of melanocytes occuring on skin and mucosa
Term
Where do malignant melanomas occur? Is the incidence of these increasing? What is the etiology of oral melanoma?
Definition
-On skin, develop on sun-exposed areas after prolonged exposure to strong sunlight
-Incidence is increasing
-Oral melanoma unknown etiology and is rare compared to skin melanoma
Term
How do oral and skin malignant melanomas occur? How common is oral? WHat is the pronosis like?
Definition
-Both appear as dark brown, blue-black or black that first appear as a macule and become papular or nodular later
-Oral = 2-8% but median survival time is 18 months
-5 Year Survival Rates, Oral = 5-20%, Skin = 84%
Term
What is the treatment for malignant melnomas?
Definition
Surgical removal with wide margins (1–3 cm)
Term
What are the 2 phases that malignant melanomas grow in?
Definition
-initially neoplastic cells spread laterally in the epithelium
-then begin a vertical growth phase when they invade the connective tissue
Term
How does horizontal growth of malignant melanomas look?
Definition
Horizontal growths appears as an irregular shaped macule which may become larger, become more pigmented, and ulcerate
Term
How many malignant melanomas grow horizontally account for? Vertically?
Definition
horizontal- 80%
Vertical- 15%
Term
How long may the initial phase of malignant melanoma last? What is the prognosis for vertical growth? What is a third type of melanotic lesion?
Definition
-several months to several years
-prognosis for vertical is poor
-A third type of melanoma arises in a pre-existing pigmented lesions
Term
What can tumors in the oral cavity be a result of?
Definition
cancer elsewhere in the body metastasizing
Term
Where is the most common site of metastatic tumors?
Definition
the mandible
Term
What is the treatment for metastatic tumors? Prognosis?
Definition
-chemo and radiation
-prognosis is poor
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