Recording-2025-03-12T19:04:13.987Z

Overview

• Aim of the session: Improve confidence in identifying oral lesions, particularly red and white patches.

• Importance of differentiating between benign, potentially malignant, and malignant lesions.

• Understanding when to reassure, treat, or refer patients.

Classification of Oral Lesions

• Classification based on color can be messy, better to categorize:

  • Benign or Infectious Lesions

  • Potentially Malignant Lesions

  • Malignant Lesions

Common Oral Lesions

White Patches

• Conditions presenting as white patches: e.g., SCC (Squamous Cell Carcinoma), oral lichen planus, leucoplakia, etc.

• Some lesions may transition between red and white appearances.

• Examples to cover: candida, leukoplakia, etc.

Red Patches

• Conditions that can present as red patches: e.g., ulcers, erythroplakia (high risk of malignancy).

• Importance of distinguishing between benign causes and those requiring urgent referrals.

Systematic Approach to Diagnosis

• Utilize a systematic approach, such as the surgical sieve, can help in forming differential diagnoses.

• Consider factors such as trauma, dental problems, metabolic diseases, etc.

Clinical Example Case Study

Example: Elderly Male with Tongue Ulcer

• Patient profile: 45 years old, heavy smoker, presenting with a tongue ulcer for six weeks, indurated but pain-free.

• Historical context: Need to consider risk factors for SCC, the importance of identifying non-painful ulcers that may indicate malignancy.

• Distinguishing features of lesions like traumatic ulcers vs. major aphthous ulcers, syphilis, or SCC.

Distinguishing Features of Lesions

• Traumatic Ulcers: Indurated, keratotic border, associated with trauma from sharp teeth.

• Aphthous Ulcers: More inflamed margins; major aphthous ulceration is distinct in healing timelines.

• Infectious Causes: Suited for diagnoses like syphilis or candida where patient history is key.

Oral Cancer Insights

• High rates of oral cancer due to societal factors, socioeconomic deprivation impacting risk.

• Urgent referrals necessary for suspicious lesions:

  • Lesions that bleed (spontaneous or contact bleeding) should raise immediate concern.

  • Early diagnosis is crucial, with a high survival rate (90%) if detected early.

Benign Oral Lesions

Leukoedema

• Harmless lesion; appearance changes when buccal mucosa stretched.

• Reassurance sufficient; no biopsy required.

Erythema Migrans (Geographic Tongue)

• Benign condition where patches may migrate over time.

• Asymptomatic cases can be managed without referral, but symptomatic cases might require further investigation or treatment.

Candida Infections

• Candida: Common opportunistic infection appearing in immunocompromised patients.

• Types:

  • Acute pseudomembranous: Easily wiped off, leaving an erythematous base.

  • Chronic erythematous: Often linked to denture wear.

• Important to manage underlying risk factors to prevent recurrence.

Potentially Malignant Disorders

Leukoplakia

• White patches with potential cancer risk, inability to wipe off indicates need for referral.

• Assess for dysplasia via biopsy and follow up based on results.

Erythroplakia

• Red lesions have a high rate of dysplasia; urgent referral required upon suspicion.

Lichen Planus

• An immune-mediated inflammatory disease affecting various demographics.

• Different presentations (reticular, erosive) observed. Referral necessary for symptomatic cases.

• Importance of monitoring for malignancy and managing any dysplastic changes.

Final Notes and Recommendations

• Encourage patients for self-examinations and reporting new or worsening symptoms.

• Utilize proper referral pathways based on observed lesions and patient risk factors.

• Always consider underlying health conditions and comprehensive oral hygiene practices.