Malignant Epithelial Neoplasms

What are the main 3 malignant epithelial neoplasm?

1. Basal Cell Carcinoma

2. Squamous Cell Carcinoma

3. Verrucous Carcinoma

Basal Cell Carcinoma

Squamous Cell Carcinoma

Verrucous Carcinoma

What is another name for basal cell carcinoma (BCC)?

Rodent Ulcer

What is basal cell carcinoma (BCC)?

A low grade epithelial malignancy that is the most common skin cancer and most common of all cancers

What is basal cell carcinoma (BCC) caused by?

Sun exposure

What is the prevalence of BCC?

80% in the head and neck

Which demographic do you see basal cell carcinoma (BCC) in?

Age > 40 years

What is the treatment for basal cell carcinoma (BCC)?

Surgical excision

What are some clinical features of basal cell carcinoma (BCC)?

• Begins as a firm, painless papule

• Slowly enlarges and gradually develops a central depression (non healing indurated ulcer)

• Rolled borders are usually present

• One or more telangiectatic blood vessels are seen

• Metastasis is extremely rare

• Locally destructive

What is the most common type of basal cell carcinoma (BCC)?

Noduloulcerative- slightly elevated and central ulcer

What is morpheaform-sclerosing?

A scar-like appearing form of basal cell carcinoma (BCC)

Superficial basal cell carcinoma (BCC)

Locally destructive basal cell carcinoma (BCC)

Pigmented basal cell carcinoma (BCC)

What is cutaneous squamous cell carcinoma caused by?

Chronic sun exposure

What is the precursor to cutaneous squamous cell carcinoma?

Actinic keratosis

What is the treatment for cutaneous squamous cell carcinoma?

Usually excision but radiation therapy is an option

Where would you find cutaneous squamous cell carcinoma?

70% in the head and neck region as a non-healing ulcer

What are some characteristics of cutaneous squamous cell carcinoma?

• Slowly growing

• Plaque, papule or nodule variable degree of scale, ulcer or crust

• Often erythematous base

What is another name for Verrucous Carcinoma?

“Snuff Dipper’s Cancer/ Ackerman’s Tumor”

What is Verrucous Carcinoma?

Diffuse, well-demarcated, painless, thick plaque with papillary or verruciform surface projections

Low-grade variant of oral squamous cell carcinoma (90% disease-free survival)

What are the causes of Verrucous Carcinoma?

Smokeless tobacco or PVL

Where might you find Verrucous Carcinoma?

Mandibular vestibule and gingiva

What is the prevalence of Verrucous Carcinoma?

20% have an SCC developing within the verrucous carcinoma

What is the treatment for Verrucous Carcinoma?

Surgical excision

What are the two types of squamous cell carcinoma?

The conventional type: oral conventional (HPV-)

Oral HPV+

Factoids about oral cancer

• 1 in 3 Americans develop a malignancy and 2/3 survive

• Cancer accounts for 20% of all deaths in the US

• Oral cancer accounts for 3% of all cancers

  • 95% of these are SCC

• Cause of oral SCC is multifactorial

What are some etiologies of oral cancer

• Vitamin A deficiency

• Iron deficiency anemia

• Smoking

• Alcohol

• Radiation therapy

• Fennel agents chemicals

• Immunosuppression such as HIV

• 25% not associated with risk factors

• <40 years old

• Lateral/ventral tongue

In what demographic would you find oral squamous cell carcinoma?

Caucasian men and older age group, but both of these factors are changing

Where would you find oral squamous cell carcinoma?

Floor of mouth, posterior lateral ventral tongue, lower lip

Why is there a delay in seeking care of oral squamous cell carcinoma?

Because the earlier stags are painless

What are some clinical features of oral squamous cell carcinoma?

• Endophytic (ulcerated)

• Leukoplakic

• Erythroleukoplakic

• Exophytic (fungating)

What site has the highest risk of dysplasia and cancer?

1. Floor of the mouth

2. Lateral border ventral surface of the tongue

3. Lower lip

4. Soft palate

Where would you find lip squamous cell carcinoma?

Lower lip is more common, upper lip is rare

What is the cause of lip squamous cell carcinoma?

Due to chronic sun exposure

Arises in a setting of actinic cheilitis

What are some features of lip squamous cell carcinoma?

• Slow non-healing ulcer

• Rough and scaly

• Can be mistaken for an ulcer

Survival rate of OSCC vs Lip SCC

Stage 1- No metastases

Stage 4- High metastases

How does squamous cell carcinoma spread?

Through the lymphatics- ipsilateral cervical lymph nodes

How will nodes present as in OSCC?

• Firm to stony hard

• Painless

• Enlarged

• FIxed (if the cells have perforated the capsule of the node and invaded into the surrounding tissues)

Where would you find metastases in OSCC?

Local metastasis in lymph nodes in neck, distant metastasis is below the clavicles
Most commonly found in lungs and bones

What is a sentinel lymph node?

The first lymph node to which cancer cells are most likely to spread from a primary tumor

What is the staging and prognosis steps for OSCC?

TNM staging dictates treatment and best indicator of patient prognosis (which is determined by tumor size and extent of metastatic spread)

T= size of primary local tumor in centimeters

N = involvement of local lymph nodes

M = Distant metastasis

What are the microscopic features on the grading scale for OSCC, grade 1?

• Tumors resemble their parent tissue

• Grow slowly

• Well-differentiated

• Low grade

What are the microscopic features on the grading scale for OSCC, grade 2?

• Tumors that less resemble their parent tissue

• Moderately-differentiated

• Intermediate-grade

What are the microscopic features on the grading scale for OSCC, grade 3?

• Tumors little resemblance to parent tissue tend to enlarge rapidly

• Metastasize early

• Poorly differentiated

• High grade

What is a better prognostic indicator?

Clinical staging > histologic grading

What is the treatment for cutaneous SCC?

Surgical excision and good prognosis if detected early

What is the treatment for lip carcinoma?

Wedge resection with excellent results: 10% recurrence, 5-year survival approaches 100% in lower lip

What is the treatment for OSCC? (clinical stage guides treatment)

• Wide surgical excision and/or radiation therapy

• Chemotherapy is sometimes administered

  • Does not improve survival time

Patients with intraoral tumors that have 4mm depth of invasion receive what?

Radical neck dissection

What type of HPV + OSCC is high risk type?

> 70% are HPV+, high risk type HPV 16

Where would you find HPV+OSCC?

Soft palate, tonsillar region, base of tongue

What are the clinical features of HPV+OSCC?

A mass or an Erythroplakia

What are locations of HPV+OSCC and their incidence?

• Neck mass 51%

• Sore throat 28%

• Dysphagia 10%

What is the treatment for HPV+OSCC?

Radiation therapy, surgery, and chemo

Which has a better prognosis, HPV+OSCC or OSCC?

HPV+OSCC

Comparison of HPV+OSCC and OSCC

What is the risk profile for HPV+OSCC?

• Tobacco is NOT the cause

• Male predilection

• Adults

• Increase in sexual partners

• Location: Oropharyngeal/tonsillar

What is the treatment of HPV+ OSCC

(1st) Radiation therapy, surgery and chemo