Ulcerated lesions 1
describing clinical presentation:
size
distribution
color
type
location
INFECTIOUS/INFLAMMATORY AND NEOPLASTIC
Primary Herpetic gingivostomatitis
-differential: primary herpetic gingivostomatitis, herpetiform aphthous ulcerations, oral manifestations of Crohn’s disease
-affected areas: keratinized and nonkeratinized mucosae
-Causative organism: HSV-1 or HHV-1
-treatment: supportive care, hydration, pain control, systemic therapy with acyclovir, valacyclovir
Histoplasmosis
-differential: SCC, deep fungal infection, traumatic ulcer/TUGSE, major aphthous ulceration, autoimmune process
-affected areas: anywhere
-causative organism: histoplasma capsulatum
-treatment: IV liposomal amphotericin B and oral itraconazole
Shingles (Herpes Zoster)
-differential: Herpes zoster, intraoral herpes injection in an immunocompromised patient, allergic stomatitis, autoimmune process
-affected areas: anywhere-normally on one side of the body and will stop abruptly at a midline rather than crossing over
-causative organism: reactivation of latent varicella zoster virus
-treatment: supportive care, hydration, pain control, and systemic therapy with acyclovir/valacyclovir. Shingrix-shingles vaccine for adults 50+
Recurrent intraoral herpes
-differential: secondary/recurrent intraoral herpes, traumatic ulcerations, autoimmune process
-affected areas: ONLY keratinized or attached mucosae (gingiva/hard palate) in immunocompetent individuals
-causative organism: Reactivation of latent herpes simplex virus 1
-treatment: supportive care, hydration, pain control;acyclovir/valacyclovir (start within 48hr)
Squamous Cell Carcinoma
-differential: SCC, deep fungal infection, Kaposi sarcoma, traumatic ulcer, TUGSE
-affected areas: anywhere
-causative organism: lowkey anything but norm. really bad lesions/ulcerations
-treatment: refer to oral and maxillofacial/ENT surgeon for wide surgical excision with lean margins, +/- lymph node neck dissection, with chemo/radiation therapy based on TNM staging
ULCERATED LESIONS II-auto-immune/Immune related/Allergy or Traumatic/reactive
Aphthous stomatitis
-differential: recurremt minor aphthous ulceration, traumatic ulceration. crohn’s disease. behcet syndrome, nutritional defic
-affected areas: nonkeratinized mucosa
-etiology: t-ce;; mediated immunologic reaction with involvement of tumor necrosis factor alpha
-tx: mild- no tx or otc anestetics or protective bioadhesive
severe- topical Corticosteroid gels
Herpetiform aphthous ulcerations
-differential: recurrent aphthous ulcerations-herpetiform, Herpes virus infection. R/O Crohn’s disease, Behcet syndrome, nutritional deficiences
-affected areas: nonkeratinized mucosae
-etiology: T cell mediated immunologic reaction with involvement of tumor necrosis factor alpha destructive disease
-tx: mild- no tx or otc for pain or protective bioadhesive products
severe- corticosteroid rinse
Erythema multiforme-crusty lips
-differential: erythema multiforme, infectious ulcers, allergic rxn
-affected areas: na
-etiology: immune mediated abnormal t cell response to HSV, mycoplasma, NSAIDS, antibiotics, antifungals, and antivirals
-tx: symptomatic relief- IV rehydration with topical anesthetic agents to decrease discomfort. If due to meds-discontinue. If triggered by HSV, acyclovir
Erosive lichen planus
-differential: erosive lichen planus, lichenoid drug rxn, lichenoid foreign body rxn, graft vs host disease, lupus erythematosus, vesiculobullous disorders, dysplastic leukoplakia ulceration
-affected areas: na
-etiology: immune mediated abnormal t cell response- autoimmune condition but the target antigen hasn’t been identified
-tx: erosive- topical corticosteroids AFTER BIOPSY PROVEN CONFIRMED DIAGNOSIS
diprolene gel
Mucous membrane pemphigoid/pemphigus
-differential: erosive lichen planus, mucous membrane pemphigoid, pemphigus, allergic/contact stomatitis
-affected areas: na
-etiology: immune mediated response, autoimmune tissue bound autoantibodies are directed against proteins in the basement membrane/hemidesmosomes
-tx: topical corticosteroids AFTER BIOPSY PROVEN CONFIRMED DIAGNOSIS, referral ophthalmologist
PIGMENTED LESIONS
Oral Mucosal Melanoma-neoplastic
-etiology: malignant neoplasm of melanocytic origin
-clinical features: often nodular at diagnosis. 75% occur on the hard palate or maxillary alveolus. Lesion usually begins as a brown or black macule that extends laterally with the development of a lobulated exophytic mass. cervical lymph node metastasis is often present
-diagnosis: diagnostic biopsy
Treatment: radicular surgery often with radiation therapy; poor prognosis
Kaposi Sarcoma-neoplastic
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Amalgam tattoo-reactive
-etiology: contamination of pre-existing oral mucosal wound with amalgam particles
-clinical features: blue-black macules with well defined or irregular borders. Most common gingiva, alveolar mucosa, and buccal mucosa; rarely show up on x-rays
-diagnosis: radiographs, diagnostic biopsy if radiographs negative
Treatment: none
Smoker’s Melanosis
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Oral Melanoacanthoma
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Drug-related discolorations
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Neurofibromatosis type 1- genetic
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Addison Disease (hypoadrenocorticism)
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Peutz-Jeghers Syndrome
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McCune Albright Syndrome
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Oral melanotic macule- idiopathic
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Acquired Melanocytic nevus (mole)
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Blue Nevus
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EXTRAORAL LESIONS
Basal Cell Carcinoma
-etiology: most common malignancy in humans; hair follicles and eccrine sweat glands; UVB radiation
-clinical features: 5 clinical patters- nodular (most common), superficial, micronodular, infiltrative, morpheaform
-diagnosis:
-treatment:
Seborrheic Keratosis
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