PRE-MALIGNANT TUMORS

A white patch occurring on the surface of the mucous membrane in areas such as the oral cavity, vulva, uterine cervix, urinary bladder, renal pelvis, and upper respiratory tract.

LEUKOPLAKIA

What areas can the Leukoplakia be found? ovuuru

oral cavity, vulva, uterine cervix, urinary bladder, renal pelvis, and upper respiratory tract

What are the etiological factors of Leukoplakia? (7)

Tobacco (tars and resins), alcohol, chronic irritation (e.g., malocclusion, ill-fitting dentures), syphilis, vitamin deficiency, hormones, and candidosis.

tars and resins

Tobacco

2 conditions associated with Tobacco

Stomatitis Nicotina (pipe’s smoker palate)
Cigarette smoker’s lip lesion

malocclussion (cheek-biting), ill-fitting dentures, broken teeth

Chronic irritation

What are the clinical features of Leukoplakia?

More common in older men, it progresses through three stages: non-palpable, faintly translucent white discoloration; localized or diffuse slightly elevated plaques; thickened white lesions showing induration, fissuring, and ulceration.

3 stages in Leukoplakia NLP

non-palpable, faintly translucent white discoloration; localized or diffuse slightly elevated plaques; thickened white lesions showing induration, fissuring, and ulceration.

What are the histological features observed in Leukoplakia? hhadc

Hyperorthokeratosis, hyperparakeratosis, acanthosis, dysplasia, and carcinoma in situ.

orthokeratin thickness

Hyperorthokeratosis

parakeratin

Hyperparakeratosis

stratum spinosum

Acanthosis

Tx for leukoplakia (2)

elimination of recognizable irritation factors

excision or cauterization

an abnormality of the buccal mucosa that clinically resembles early leukoplakia, characterized by changes in the appearance of the mucous membrane

Leukoedema

What are the clinical features of Leukoedema? FBN

Vary from filmy opalescence to a more definite grayish white cast with a coarsely wrinkled surface. It is bilateral in the buccal mucosa, extending onto the oral surface of the lips (occlusal line), most commonly seen in Negro individuals around 45 years old

What are the histological features of Leukoedema? EISB

• Increase in thickness of the epithelium.

• Intracellular edema of the spinous or malpighian layer.

• Superficial parakeratotic layer several cells in thickness.

• Broad rete pegs.

Tx for leukedema

none, variant of normal mucosa

exhibits epithelial changes ranging from mild dysplasia to carcinoma in situ (CIS) to invasive carcinoma.

Erythroplakia

What are the 3 clinical manifestations of erythroplakia in the oral cavity?

Homogenous form

Speckled form

Bright red, soft velvety lesion with straight or scalloped well-demarcated margins

Homogenous form

Extensive erythroplakia/homogenous form affects bstf

buccal mucosa, soft palate, tongue, and floor of the mouth

Erythroplakia interspersed with leukoplakia, where the erythematous areas are irregular and often not as bright red as the homogenous form

Speckled form

Soft, red lesions that are slightly elevated with an irregular outline and a granular or finely nodular surface, sometimes referred to as

Speckled Erythroplakia

Erythroplakia occurs in the __________ decades of life, affecting areas like the floor of the mouth, retromolar area, tongue, palate, and mandibular mucosa and sulcus

6th and 7th

Erythroplakia affecting areas like FRTPM

floor of the mouth, retromolar area, tongue, palate, and mandibular mucosa and sulcus

What are the histological features of Erythroplakia? ICE

• Invasive epidermoid carcinoma

• Carcinoma in situ

• Epithelial dysplasia

Fairly shallow lesion with degrees of differentiation

Invasive epidermoid carcinoma

Epithelial dysplasia throughout the entire thickness of the lesion without invasion of the underlying connective tissue

Carcinoma in situ

What is the treatment for Erythroplakia?

Same as invasive epidermoid carcinoma or carcinoma in situ.

Carcinoma in situ that occurs in the skin and mucous membranes, including the oral cavity

Intraepithelial Carcinoma

What are the clinical features of Intraepithelial Carcinoma?

Commonly found in intraoral sites such as:

• Floor of the mouth

• Tongue

• Lips (especially in elderly males)

An insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx, associated with juxta-epithelial inflammatory reaction, fibroelastic changes of the lamina propria, and epithelial atrophy, leading to stiffness of the oral mucosa, trismus, and inability to eat

Oral Submucous Fibrosis

What are the etiological factors of Oral Submucous Fibrosis? CVPB

• Chillies

• Vitamin B deficiency

• Protein deficiency

• Betel nut chewing

a strongly irritating spice commonly used in India.

Chillies

What are the clinical features of Oral Submucous Fibrosis? bfes

• Burning sensation of the mouth when consuming spicy foods.

• Formation of vesicles (palate), ulcerations, or recurrent stomatitis.

• Excessive salivation and defective gustatory sensation.

• Stiffening of certain areas of the oral mucosa, causing difficulty in opening the mouth and swallowing.

• Most commonly affects individuals aged 20 to 40 years.

What are the histological features of Oral Submucous Fibrosis? ESF

• Oral epithelium is extremely atrophic with complete loss of rete pegs.

• The underlying connective tissue shows severe hyalinization with homogenization of collagen bundles.

• Diminished fibroblasts and obliterated, narrowed blood vessels.

What is the treatment and prognosis for Oral Submucous Fibrosis?

Treatment often involves systemic corticosteroids and local hydrocortisone, providing only temporary remissions.