AQ

Module 12: Soft Tissue Lesions

Why Look for Lesions?

  • In June 2003, the ADA launched a campaign urging dental professionals to examine patients for signs of soft tissue lesions.

  • Dental health care providers have a unique opportunity to detect skin and oral lesions early.

  • Goal: reduce deaths from skin, oral, and pharyngeal cancers through: Early detection; Appropriate treatment; Referral.

Facts about Skin Cancer

  • Most common cancer type

  • More than 1{,}000{,}000 diagnosed yearly in the United States => >10^6

  • When detected at the earliest stages, skin and oral cancers are more easily treated and cured.

Two Main Types of Skin Cancers

  • Melanoma

  • Nonmelanoma

Melanoma

  • Much more likely to spread to other parts of the body.

  • Accounts for more than 60\% of skin cancer deaths.

  • Always treatable if caught soon enough.

Malignant Melanoma

  • (Context: a key, high-risk skin cancer.)

Nonmelanoma

  • Basal Cell Carcinoma: ~60\% of skin cancers; most common skin cancer; rarely spreads; less likely to be fatal.

  • Squamous Cell Carcinoma: ~20\% of skin cancers; common; rarely fatal; less common than melanoma in mortality terms.

Oral and Pharyngeal Cancer Facts

  • 3.0\times 10^4 new cases diagnosed yearly in the United States

  • More than frac{1}{4} (≈25\%) patients with oral cancer will die (
    >25\%)

  • Claims almost as many lives as melanoma

What Is a Soft Tissue Lesion?

  • An area of abnormal-appearing skin or oral mucosa that does not resemble the soft tissue surrounding it.

  • A variation in color, texture, or form of an area of skin or oral mucosa.

Variation in Color

  • Colors observed: white, red, blue, black, yellow, brown.

Variation in Texture

  • Lesions may differ in surface texture from surrounding tissue (e.g., smooth vs rough).

Variation in Form

  • Lesions may differ in shape and elevation (e.g., flat, raised, fluid-filled, depressed).

A soft tissue lesion may be:

  • Present at birth (birthmark).

  • Associated with an infection (wart, acne).

  • Associated with an allergic reaction (hives).

  • Associated with an injury (blister, scar).

What Tools Can We Use for Prevention and Detection of Soft Tissue Lesions?

  • Tools include comprehensive observation and history-taking as part of routine dental care.

Characteristics of Soft Tissue Lesions (Overview)

  • Lesions differ from surrounding skin or mucosa in border, margin, color, configuration, and elevation/depression.

  • Key properties to note: border, margin, color, configuration, dimensions, and whether the lesion is flat, elevated, fluid-filled, or depressed.

Characteristics that Differ from Surrounding Skin or Mucosa

  • Border can be regular or irregular.

  • Margins may be smooth or raised.

  • Lesions may cluster together.

  • Colors can differ (white, red, blue, black, yellow, brown).

  • Lesions may be flat, raised, fluid-filled, or depressed.

  • Configuration of lesions varies.

Lesion Border Traits

  • Regular Border

  • Irregular Border

Lesion Margin Traits

  • Smooth Margin: level with surrounding tissue.

  • Raised Margin

Lesion Color

  • Red and White Lesion

  • White Lesion

  • Yellow Lesion

  • Blue Lesion

Common Configurations

  • Discrete Configuration: separate lesions

  • Grouped Configuration

  • Confluent Configuration: merged lesions

  • Linear Configuration: lesions form a line

Flat Lesions

  • Flat lesions detectable only by color difference from surrounding tissue.

  • Macule: small, flat discolored spot.

  • Macule example: flat, red lesion.

  • Patch: flat, discolored spot.

Elevated Lesions

  • Surface of lesion is raised above the normal level.

  • Papule: solid, raised lesion < 1\text{ cm}

  • Plaque: superficial raised lesion

  • Nodule: raised, marble-like lesion

  • Wheal: raised, irregular area of edema

Fluid-Filled Lesions

  • Fluid-Filled Lesions: elevated lesion filled with clear fluid or pus

  • Vesicle: small blister filled with clear fluid

  • Bulla: large blister

  • Pustule: pus-filled lesion

Depressed Lesions

  • Surface of lesion is below the normal level of skin or mucosa.

  • Most depressed lesions are ulcers.

  • Superficial Ulcer: depth <3\ \text{mm}

  • Deep Ulcer: depth >3\ \text{mm}

Linear Cracks and Fissures

  • Linear Crack: a long, narrow break in the surface of the skin or mucosa.

  • Fissure: linear crack in the top two layers of skin.

Why is it important to describe a lesion? Can’t I just point to it?

  • All dental health care providers must know the terminology related to lesions to communicate effectively.

  • A precise description should be recorded in the patient record to:

    • document the finding to meet standards of care,

    • assist other clinicians in quickly locating the lesion,

    • facilitate referrals to dental specialists,

    • allow comparison of today’s findings with those from weeks or months ago.

Lesion Descriptors

  • Characteristics

  • Anatomic location

  • Border traits

  • Color

  • Configuration

  • Dimensions

Lesion Descriptions (cont.)

  • Primary types: Flat, Elevated, Fluid-filled, Depressed

  • Because lesions have many characteristics, clinicians may feel overwhelmed documenting them.

Formula for Describing Lesions (ABCD-T)

  • A — Anatomic location

  • B — Border

  • C — Color and configuration

  • D — Dimension

  • T — Type

ABCD-T: Describe this lesion

  • A, B, C, D, T framework used to standardize descriptions

Tools for Cancer Detection

  • Head and neck examination

  • Oral examination

  • Patient history

  • Awareness of alcohol and tobacco use

Dental Professional’s Role in Cancer Detection

  • Examine using a systematic visual inspection

  • Elicit information on tobacco and alcohol use

  • Educate patients: tobacco and alcohol use dramatically increases risk of oral cancer

  • Identify: locate and document any suspicious lesions

  • Refer: to dermatologist (skin lesions) or oral maxillofacial surgeon (oral lesions)

  • Follow-up: ensure specialist was seen and a definitive diagnosis was obtained

Recap: Soft Tissue Lesions

  • A soft tissue lesion is an area of abnormal-appearing skin or oral mucosa.

  • A lesion may differ from surrounding skin or oral mucosa in color, texture, or form.

  • More than 1{,}000{,}000 diagnosed yearly in the United States; early detection improves treatment and outcomes.

Recap: Lesion Characteristics

  • Noting border, color, whether single or grouped, and whether flat, raised, fluid-filled, or depressed.

Recap: Describing Lesions

  • Accurate documentation is essential for care standards, communication, referrals, and longitudinal comparison.

  • Use ABCD-T to remember the characteristics to look for: A,B,C,D,T

Final takeaway

  • Systematic approach to detection, description, and referral improves early detection of skin and oral cancers and supports better patient outcomes.