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OPT Epithelial

oral squamous papilloma benign HPV 6&11 induced proliferation of stratified squamous epithelium
recurrent respiratory papillomatosis (RRP) papillomas in respiratory tract; juvenile and adult onset
juvenile-onset RRP passed to fetus from mother with genital warts; laryngeal papillomas
adult-onset RRP laryngeal papillomas that cause hoarseness
verruca vulgaris common wart; benign proliferation of squamous epithelium induced by HPV-2 that is contagious
condyloma accuminatum (venereal wart) HPV-induced proliferation of squamous epithelium transmitted sexually
multifocal epithelial hyperplasia (Heck disease) proliferation from HPV 13&32; papules on lips and tongue
sinonasal papilloma benign proliferations of sinonasal mucosa, not always induced by HPV
molluscum contagiosum epithelial proliferation induced by this member of the DNA poxvirus; pink umbilicated papules on head and genitals
verruciform xanthoma squamous proliferation mainly in mouth of unknown cause; fine papillary surface with white/yellow/red color
seborrheic keratosis on sun-exposed skin but not in mouth; benign tan-brown macules that have 'stuck-on' appearance
sign of Leser-Trelat sudden appearance of many seborrheic keratoses
sebaceous hyperplasia localized proliferation of sebaceous glands in nose, cheeks and forehead; resembles basal cell carcinoma
Muir-Torre syndrome autosomal dominant disorder of sebaceous hyperplasia, malignancies and keratoacanthomas
ephelis (freckle) hyperpigmented macule, more often in fair-skinned, blue-eyed people
actinic lentigo (solar lentigo) well-demarcated pigmented brown macule on sun-exposed skin in old people
lentigo simplex benign cutaneous melanocytic hyperplasia not caused by sun-exposure; LEOPARD syndrome
melasma 'mask of pregnancy'; hyperpigmentation of face and neck, can also be due to oral contraceptives
oral melanotic macule (focal melanosis) increase of melanin in basal layer of oral mucosa; usually solitary and benign but resembles melanoma
acquired melanocytic nevus (mole) proliferation of neural crest nevus cells that migrate to epidermis; associated with BRAF mutation
junctional nevus increased nevus cells along basal layer, forming 'theques'; flat and demarcated
compound nevus nevus cells in junctional area and superficial CT; slightly elevated
intradermal nevus all nevus cells in CT; raised with papillomatous surface
intramucosal nevus intradermal nevus in the mouth; most common melanocytic spot in mouth
congenital malanocytic nevus present at birth and more malignant than acquired forms
halo nevus zone of depgimentation surrounding nevus due to immunologic attack
spitz nevus nevus that mimics melanoma seen in children
blue nevus 'Tyndall effect' gives nevus a blue color since deep in CT; common type in oral cavity
leukoplakia white patch or plaque that cannot be rubbed off and isn't anything else; no histopathologic change -premalignant, especially in smokers and become SCC on lateral tongue, floor and lower lip in particular -biopsy and microscopic evaluation is mandatory
verruciform leukoplakia leukoplakia with surface irregularities with projections
erythroplakia leukoplakia with areas of redness
speckled leukoplakia/erythroleukoplakia leukoplakia with combined color change
proliferative verrucous leukoplakia (PVL) high risk, multiple plaques that progress to verrucous to SCCA
epithelial dysplasia alteration of squamous epithelium that can progress to SCCA without invasion of CT
erythroplakia red patch or plaque not diagnosed as anything else; almost all have epithelial dysplasia, carcinoma in situ, or invasive SCCA so should be biopsied ASAP
smokeless tobacco keratosis thickened and white mucosa where tobacco is placed; should be biopsied if remains 6 weeks after cessation
oral submucous fibrosis chronic, progressive scarring at high risk for SCCA, from chewing betel quid
nicotine stomatitis seen on palate in pipe and cigar smokers, due to heat rather than chemicals
actinic keratosis (solar keratosis) from UV exposure, precancerous scaly plaque with sandpaper surface
actinic cheilosis lesion on lower lip vermillion in males; scaly with possible ulcerations
keratoacanthoma self-limiting, mimics SCCA in sun-exposed areas; dome-shaped nodule with keratin plug
squamous cell carcinoma malignancy of stratified squamous epithelium, 90% of oral malignancies
HIV-positive oropharyngeal carcinoma SSCA that is on the rise, related to HPV transmission via oral sex
tobacco smoke has over 70 carcinogens and produces free radicals to increase risk of SCCA
smokeless tobacco increases risk for SCCA but depends on type; dry snuff is worse than wet snuff
alcohol not initiating factor for SCCA but potentiates other effects
Plummer-Vinson syndrome severe iron-deficiency anemia with increased risk for SCCA on pharynx
oncogenic viruses high risk HPV can increase risk of SCCA especially HPV-16
immunosuppression diminished immune system can affect development of SCCA
ocogenes and tumor suppressor genes can be acted on by viruses, radiation and carcinogens to allow cancer to develop
SCCA of lip vermillion 90% on the lower lip; crusted, ulcerated mass that grows slowly
tongue most common site of intraoral SCCA, usually on lateral and ventral surfaces
SCCA of floor of mouth arises from preexisting leukoplakia/erythroplakia; most likely to metastasize
gingival and alveolar SCCA irregular lesion that spreads laterally along the gingiva
SCCA of buccal mucosa worse prognosis with tendency to metastasize
oropharyngeal SCCA in posterior region of oral cavity, usually larger and higher chance to metastasize
metastatic spread largely spread through lymphatics to cervical lymph nodes
TNM (tumor-node-metastasis) staging of cancer based on size of primary tumor, metastasis to regional nodes and distant metastases
treatment of oral SCCA guided by clinical stage, location; includes excision, chemo, radiation or combination
tumor stage best prognostic indicator for lip and intraoral carcinomas
HPV-status best prognostic indicator for oropharyngeal carcinomas
verrucous carcinoma low-grade SCCA usually at site of cewing tobacco; large, white thick plaque
spindle cell carcinoma rare variant of SCCA with invasive portion of tumor formed by spindle-shaped epithelial cells that mimic sarcomas; fast-growing and metastasizes early
adenosquamous carcinoma rare, high grade variant of SCCA with combination of surface SCCA and underlying adenocarcinoma; sometimes produces mucin, almost universal cervical lymph node metastasis at time of discovery
basaloid squamous carcinoma high-grade SCCA variant with high association with alcohol and smoking; usually late stage at diagnosis
carcinoma of maxillary sinus uncommon and usually SCCA; chronic sinusitis at first then fast progressing to pain and paresthesia
sinonasal undifferentiated carcinoma (SNUC) high-grade malignancy of nasal cavity; rapid growth and tumor necrosis
nasopharyngeal carcinoma cancer of lymphoid-rich nasopharynx, endemic in China; associated with smoking, EBV, enlarged cervical nodes
basal cell carcinoma most common skin cancer in the US; locally invasive slow-spreading tumor from UV exposure
nodular most common BCCA, with telangiectatic blood vessels
pigmented BCCA that mimics melanoma
sclerosing BCCA that looks like a scar; perform Mohs surgery on this type
superficial BCCA that looks like psoriasis
nevoid BCCA that looks like nevus and there are usually multiple; part of nevoid basal cell carcinoma syndrome
Merkel cell carcinoma (neuroendocrine carcinoma of skin) rare aggressive malignancy from UV exposure and weak immune status; tumor cells contain granules that look like these in Merkel touch receptors
melanoma extremely fatal malignant melanocytic tumor; can occur wherever melanocytes are present
radial growth phase lateral spread of melanoma along basal cell layer
vertical growth phase melanoma tumor cells that invade the underlying connective tissue
ABC's of melanoma Asymmetry, Border irregularity, Color variegation, Diameter larger than pencil eraser, Evolving size, shape, color etc.
superficial spreading melanoma 70% of cutaneous melanomas; in interscapular area in men and back of legs in women
lentigo maligna melanoma melanoma that develops in pre-existing pigmentation on face of elderly; has long radial growth phase
nodular melanoma melanoma when vertical invasion begins immediately and sometimes shows no pigment
acral lentiginous melanoma melanoma most common in blacks and oral cavity
oral melanomas rare but usually on palate and maxillary gingiva/mucosa
depth of invasion important prognostic indicator for melanoma
Clark system classifies melanomas on 5 levels of tissue
Breslow system classifies melanoma by actual measurement of tumor thickness
treatment of cutaneous melanoma surgical excision with wide margins
sentinal node biopsy surgery used to see if first node on drainage path contains tumor to decide if more surgery should be done
mucosal melanomas of head and neck all aggressive and stage III melanomas; usually have distant metastases
Created by: Alexandra Arnold Alexandra Arnold