DOCSLIB.ORG

Oral Cancer and Potentially Malignant Lesions Contact Information

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Oral Cancer and Potentially Malignant Lesions Contact Information MAOMS Seminar June 9, 2016 Oral Malignancies and Mimics Mark A. Lerman, D.M.D. Associate Professor and Division Director of Oral Pathology Tufts University School of Dental Medicine Oral Malignancies and Mimics • Red, White, and Blue Lesions of the Oral Cavity • Oral Cancer and Potentially Malignant Lesions Contact Information • Mark A. Lerman, D.M.D. • Email: [email protected] • Website: http://dental.tufts.edu/TOPS • Appointments: 617-636-3932 Oral Malignancies and Mimics • Red, White, and Blue Lesions of the Oral Cavity • Oral Cancer and Potentially Malignant Lesions Red Lesions • Periodontal disease • Benign migratory glossitis • Inflammatory gingival nodules • Desquamative gingivitis • Localized juvenile spongiotic gingival hyperplasia • Erythroplakia Red Lesions • Periodontal disease • Benign migratory glossitis • Inflammatory gingival nodules • Desquamative gingivitis • Localized juvenile spongiotic gingival hyperplasia • Erythroplakia Benign Migratory Glossitis • Geographic tongue/ Erythema migrans • Common immune-mediated condition • One or more erythematous patches incompletely bordered by white-yellow peripheries • Involves dorsal, lateral or ventral tongue – Ectopic geographic tongue seldom seen Benign Migratory Glossitis • Clinical or microscopic diagnosis • Generally asymptomatic • Topical Benedryl or steroid may be considered for rare symptomatic cases Red Lesions • Periodontal disease • Benign migratory glossitis • Inflammatory gingival nodules • Desquamative gingivitis • Localized juvenile spongiotic gingival hyperplasia • Erythroplakia Inflammatory Gingival Nodules – Pyogenic granuloma – Peripheral giant cell granuloma – Peripheral ossifying fibroma Pyogenic Granuloma • common poorly-named reactive lesion of oral cavity – neither pyogenic nor a granuloma • may be seen in pregnant women (“pregnancy tumor”) Peripheral Giant Cell Granuloma • common pseudotumor of oral cavity • reaction to irritation or trauma • soft tissue counterpart of central giant cell granuloma Inflammatory Gingival Nodules • Treatment and Prognosis – local excision down to periosteum to minimize recurrence – if central giant cell granulomas cannot be excluded, rule out hyperparathyroidism Red Lesions • Periodontal disease • Benign migratory glossitis • Inflammatory gingival nodules • Desquamative gingivitis • Localized juvenile spongiotic gingival hyperplasia • Erythroplakia Desquamative Gingivitis • NOT a diagnosis • Clinical term to describe a manifestation of what is usually lichen planus, a hypersensitivity reaction, or mucous membrane pemphigoid Desquamative Gingivitis • Lichen planus • Contact reactions • Mucous membrane pemphigoid • Pemphigus vulgaris Oral Lichen Planus • Clinical Features – Reticular – Erosive/erythematous – Ulcerative Lichen Planus • associated with: – NSAIDs – anti-hypertensive agents – anti-hyperglycemic agents – cholesterol lowering agents – thyroid medications – anti-gout medications – amalgam restorations – cinnamon flavoring agents – herbal remedies Lichen Planus • Treatment – Fluocinonide or clobetasol gel 0.05% • Apply to affected area QID • Dispense one 15g tube • Warn patient – Dexamethasone elixir • Dispense: 240 cc • Swish for 5 minutes and expectorate QID – Monitor for candidiasis – Follow-up Mucous Membrane Pemphigoid • Antibodies to hemidesmosomes • Twice as common as pemphigus vulgaris • Average age= 50-60 • Female predilection= 2:1 Mucous Membrane Pemphigoid • Treatment – Topical steroids for oral lesions – Refer to ophthalmology Technical Considerations • When considering vesiculobullous disease… – Always include intact epithelium – Submit separate biopsies in: • 10% formalin for H&E • Michel medium for DIF – Defer empiric treatment, if possible, until after biopsy is complete Pemphigus Vulgaris • Potentially life-threatening skin and mucous membrane disease • Incidence= 1-5 per million • Average age at diagnosis= 50 • Antibodies to desmosomes • Usually seen over 50 years of age • No gender predilection • More common in people of Ashkenazi Jewish descent Pemphigus Vulgaris • Treatment and Prognosis – Corticosteroids – Azathioprine – Immunoglobulin therapy – Untreated, mortality approaches 80% Red Lesions • Periodontal disease • Benign migratory glossitis • Inflammatory gingival nodules • Desquamative gingivitis • Localized juvenile spongiotic gingival hyperplasia • Erythroplakia Localized Juvenile Spongiotic Gingival Hyperplasia • Unique pattern of gingival hyperplasia UNRELATED to dental plaque • Originally described by Darling et al. in 2007; since reported by Chang et al. in 2008 LJSGH • Most cases between ages 5-15 • Predilection for anterior facial gingiva • Asymptomatic • Bright red raised overgrowths, sometimes with papillary architecture Red Lesions • Periodontal disease • Benign migratory glossitis • Inflammatory gingival nodules • Desquamative gingivitis • Localized juvenile spongiotic gingival hyperplasia • Erythroplakia Erythroplakia • Red patch or plaque that cannot be characterized clinically or pathologically as any other disease • Uncommon, but HIGHLY suspicious for malignancy White Lesions • Leukoedema • Candidiasis • Squamous papillomas • Lichen planus • Chronic frictional keratoses • Leukoplakia White Lesions • Leukoedema • Candidiasis • Squamous papillomas • Lichen planus • Chronic frictional keratoses • Leukoplakia Leukoedema • Generalized opalescence of the mucosa • Most commonly involves buccal mucosa • More common in African-Americans and smokers • Disappears when mucosa is stretched Leukoedema • Clinical diagnosis • No treatment White Lesions • Leukoedema • Candidiasis • Squamous papillomas • Lichen planus • Chronic frictional keratoses • Leukoplakia Candidiasis Patterns • Acute – Pseudomembranous candidiasis (thrush) – Acute atrophic candidiasis • Chronic – Chronic atrophic candidiasis – Hyperplastic candidiasis – Angular cheilitis – Median rhomboid glossitis Pseudomembranous Candidiasis • White plaques • May or may not wipe away, leaving red, raw surface exposed Median Rhomboid Glossitis • Etiology unclear – Developmental vs. infectious • Flat/slightly raised erythematous rhomboid area of midline dorsal tongue Acute Atrophic Candidiasis • Erythematous candidiasis often associated with antibiotic use • Often involves midline palate Chronic Atrophic Candidiasis • Often associated with chronic denture wear – Involves gingiva in direct contact with removable prostheses • May be referred to as “denture stomatitis” Chronic Hyperplastic Candidiasis • Controversial variant • White plaques that cannot be scraped away • True leukoplakia with secondary colonization? Angular Cheilitis • Erythema or fissuring of commisure(s) • Candidal infection, often with co-infection by staph and/or strep • May be associated with loss of vertical dimension and/or salivary pooling Anti-Fungal Therapy • Polyenes – Nystatin – Amphtericin B • Imidazoles – Clotrimazole – Ketoconazole • Triazoles – Fluconazole – Itraconazole Anti-Fungal Therapy •Topical therapy •Clotrimazole 10 mg •Dispense (30-40, write exact number) troches •Dissolve one tablet in mouth 3-4x/day for two weeks •Nystatin suspension 1:100,000 iu/ml •Dispense (200-300, write exact amount) ml •Swish and expectorate (or swallow if necessary) 5 ml 3-4 x/day for two weeks Anti-Fungal Therapy •Topical therapy •Vytone 1% (hydrocortisone-iodoquinol) cream •Dispense 15 or 30 g (write exact number) tube •Apply to affected site 3-4x/day for two weeks •Mycolog II cream (nystatin-triamcinolone) •Dispense 15 or 30 g (write exact amount) tube •Apply to affected site 3-4x/day for two weeks Anti-Fungal Therapy •Systemic therapy •Fluconazole 100 mg tablets •Dispense 3-7 (write exact number) tablets •Take one tablet in the morning x 3-7 days White Lesions • Leukoedema • Candidiasis • Squamous papillomas • Lichen planus • Chronic frictional keratoses • Leukoplakia Squamous Papilloma • Papillary mass • Benign proliferation of stratified squamous epithelium • Induced by human papillomavirus – HPV types 6 and 11 found in half of oral papillomas Squamous Papilloma • Treatment and Prognosis – Conservative surgical excision (including base of lesion) – Recurrence unlikely White Lesions • Leukoedema • Candidiasis • Squamous papillomas • Lichen planus • Chronic frictional keratoses • Leukoplakia Frictional Hyperkeratosis • Chronic biting injury • Benign alveolar ridge keratosis (BARK) • Non-specific White Lesions • Leukoedema • Candidiasis • Squamous papillomas • Lichen planus • Chronic frictional keratoses • Leukoplakia Leukoplakia . Well-defined vs. Poorly-defined Borders . Localized vs. Multi-focal . Homogenous vs. Heterogenous . Speckled . Nodular . Verrucous Proliferative Leukoplakia • Proliferative verrucous leukoplakia • Multifocal leukoplakia that recurs with a tendency to undergo malignant transformation • Female predilection? • Less often associated with a history of tobacco or alcohol use Blue and Pigmented Lesions • Foreign material • Melanin • Vascular structures • Saliva • Cystic fluid Blue and Pigmented Lesions • Foreign material • Melanin • Vascular structures • Saliva • Cystic fluid Pigmented Lesions • Exogenous Pigmentation • Endogenous Pigmentation Exogenous Pigmentation Amalgam Tattoo • Black-blue-gray macule • Often appears on gingiva adjacent to restorations – May appear on any mucosal surface Heavy Metal Toxicity • Lead • Mercury • Silver • Bismuth • Gold Heavy Metal Toxicity • Pigmentation of marginal gingiva • Tongue tremor • Metallic taste • Excessive salivation • Trichotillomania • Bruxism Endogenous Pigmentation • Etiology
Load more

Recommended publications
  • The Use of Biologic Agents in the Treatment of Oral Lesions Due to Pemphigus and Behçet's Disease: a Systematic Review
    Davis GE, Sarandev G, Vaughan AT, Al-Eryani K, Enciso R. The Use of Biologic Agents in the Treatment of Oral Lesions due to Pemphigus and Behçet’s Disease: A Systematic Review. J Anesthesiol & Pain Therapy. 2020;1(1):14-23 Systematic Review Open Access The Use of Biologic Agents in the Treatment of Oral Lesions due to Pemphigus and Behçet’s Disease: A Systematic Review Gerald E. Davis II1,2, George Sarandev1, Alexander T. Vaughan1, Kamal Al-Eryani3, Reyes Enciso4* 1Advanced graduate, Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA 2Assistant Dean of Academic Affairs, Assistant Professor, Restorative Dentistry, Meharry Medical College, School of Dentistry, Nashville, Tennessee, USA 3Assistant Professor of Clinical Dentistry, Division of Periodontology, Dental Hygiene & Diagnostic Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA 4Associate Professor (Instructional), Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA Article Info Abstract Article Notes Background: Current treatments for pemphigus and Behçet’s disease, such Received: : March 11, 2019 as corticosteroids, have long-term serious adverse effects. Accepted: : April 29, 2020 Objective: The objective of this systematic review was to evaluate the *Correspondence: efficacy of biologic agents (biopharmaceuticals manufactured via a biological *Dr. Reyes Enciso, Associate Professor (Instructional), Division source) on the treatment of intraoral lesions associated with pemphigus and of Dental Public Health and Pediatric Dentistry, Herman Ostrow Behçet’s disease compared to glucocorticoids or placebo. School of Dentistry of USC, Los Angeles, California, USA; Email: [email protected].
    [Show full text]
  • Glossary for Narrative Writing
    Periodontal Assessment and Treatment Planning Gingival description Color: o pink o erythematous o cyanotic o racial pigmentation o metallic pigmentation o uniformity Contour: o recession o clefts o enlarged papillae o cratered papillae o blunted papillae o highly rolled o bulbous o knife-edged o scalloped o stippled Consistency: o firm o edematous o hyperplastic o fibrotic Band of gingiva: o amount o quality o location o treatability Bleeding tendency: o sulcus base, lining o gingival margins Suppuration Sinus tract formation Pocket depths Pseudopockets Frena Pain Other pathology Dental Description Defective restorations: o overhangs o open contacts o poor contours Fractured cusps 1 ww.links2success.biz [email protected] 914-303-6464 Caries Deposits: o Type . plaque . calculus . stain . matera alba o Location . supragingival . subgingival o Severity . mild . moderate . severe Wear facets Percussion sensitivity Tooth vitality Attrition, erosion, abrasion Occlusal plane level Occlusion findings Furcations Mobility Fremitus Radiographic findings Film dates Crown:root ratio Amount of bone loss o horizontal; vertical o localized; generalized Root length and shape Overhangs Bulbous crowns Fenestrations Dehiscences Tooth resorption Retained root tips Impacted teeth Root proximities Tilted teeth Radiolucencies/opacities Etiologic factors Local: o plaque o calculus o overhangs 2 ww.links2success.biz [email protected] 914-303-6464 o orthodontic apparatus o open margins o open contacts o improper
    [Show full text]
  • Zeroing in on the Cause of Your Patient's Facial Pain
    Feras Ghazal, DDS; Mohammed Ahmad, Zeroing in on the cause MD; Hussein Elrawy, DDS; Tamer Said, MD Department of Oral Health of your patient's facial pain (Drs. Ghazal and Elrawy) and Department of Family Medicine/Geriatrics (Drs. Ahmad and Said), The overlapping characteristics of facial pain can make it MetroHealth Medical Center, Cleveland, Ohio difficult to pinpoint the cause. This article, with a handy at-a-glance table, can help. [email protected] The authors reported no potential conflict of interest relevant to this article. acial pain is a common complaint: Up to 22% of adults PracticE in the United States experience orofacial pain during recommendationS F any 6-month period.1 Yet this type of pain can be dif- › Advise patients who have a ficult to diagnose due to the many structures of the face and temporomandibular mouth, pain referral patterns, and insufficient diagnostic tools. disorder that in addition to Specifically, extraoral facial pain can be the result of tem- taking their medication as poromandibular disorders, neuropathic disorders, vascular prescribed, they should limit disorders, or atypical causes, whereas facial pain stemming activities that require moving their jaw, modify their diet, from inside the mouth can have a dental or nondental cause and minimize stress; they (FIGURE). Overlapping characteristics can make it difficult to may require physical therapy distinguish these disorders. To help you to better diagnose and and therapeutic exercises. C manage facial pain, we describe the most common causes and underlying pathological processes. › Consider prescribing a tricyclic antidepressant for patients with persistent idiopathic facial pain. C Extraoral facial pain Extraoral pain refers to the pain that occurs on the face out- 2-15 Strength of recommendation (SoR) side of the oral cavity.
    [Show full text]
  • High Frequency of Allelic Loss in Dysplastic Lichenoid Lesions
    0023-6837/00/8002-233$03.00/0 LABORATORY INVESTIGATION Vol. 80, No. 2, p. 233, 2000 Copyright © 2000 by The United States and Canadian Academy of Pathology, Inc. Printed in U.S.A. High Frequency of Allelic Loss in Dysplastic Lichenoid Lesions Lewei Zhang, Xing Cheng, Yong-hua Li, Catherine Poh, Tao Zeng, Robert Priddy, John Lovas, Paul Freedman, Tom Daley, and Miriam P. Rosin Faculty of Dentistry (LZ, Y-HL, CP, RP), University of British Columbia, and BC Cancer Research Centre (MPR), Cancer Control Unit, Vancouver, British Columbia, School of Kinesiology (XC, TZ, MPR), Simon Fraser University, Burnaby, British Columbia, Faculty of Dentistry (JL), Dalhousie University, Halifax, Nova Scotia, and Department of Pathology (TD), University of Western Ontario, London, Ontario, Canada; and The New York Hospital Medical Center of Queens (PF), Flushing, New York SUMMARY: Oral lichen planus (OLP) is a common mucosal condition that is considered premalignant by some, whereas others argue that only lichenoid lesions with epithelial dysplasia are at risk of progressing into oral carcinoma. A recent study from this laboratory used microsatellite analysis to evaluate OLP for loss of heterozygosity (LOH) at loci on three chromosomal arms (3p, 9p, and 17p) (Am J Path 1997;Vol151:Page323-Page327). Loss on these arms is a common event in oral epithelial dysplasia and has been associated with risk of progression of oral leukoplakia to cancer. The data showed that, although dysplastic epithelium demonstrated a high frequency of LOH (40% for mild dysplasia), a significantly lower frequency of LOH was noted in OLP (6%), which is even lower than that in hyperplasia (14%).
    [Show full text]
  • Medicare Human Services (DHHS) Centers for Medicare & Coverage Issues Manual Medicaid Services (CMS) Transmittal 155 Date: MAY 1, 2002
    Department of Health & Medicare Human Services (DHHS) Centers for Medicare & Coverage Issues Manual Medicaid Services (CMS) Transmittal 155 Date: MAY 1, 2002 CHANGE REQUEST 2149 HEADER SECTION NUMBERS PAGES TO INSERT PAGES TO DELETE Table of Contents 2 1 45-30 - 45-31 2 2 NEW/REVISED MATERIAL--EFFECTIVE DATE: October 1, 2002 IMPLEMENTATION DATE: October 1, 2002 Section 45-31, Intravenous Immune Globulin’s (IVIg) for the Treatment of Autoimmune Mucocutaneous Blistering Diseases, is added to provide limited coverage for the use of IVIg for the treatment of biopsy-proven (1) Pemphigus Vulgaris, (2) Pemphigus Foliaceus, (3) Bullous Pemphigoid, (4) Mucous Membrane Pemphigoid (a.k.a., Cicatricial Pemphigoid), and (5) Epidermolysis Bullosa Acquisita. Use J1563 to bill for IVIg for the treatment of biopsy-proven (1) Pemphigus Vulgaris, (2) Pemphigus Foliaceus, (3) Bullous Pemphigoid, (4) Mucous Membrane Pemphigoid, and (5) Epidermolysis Bullosa Acquisita. This revision to the Coverage Issues Manual is a national coverage decision (NCD). The NCDs are binding on all Medicare carriers, intermediaries, peer review organizations, health maintenance organizations, competitive medical plans, and health care prepayment plans. Under 42 CFR 422.256(b), an NCD that expands coverage is also binding on a Medicare+Choice Organization. In addition, an administrative law judge may not review an NCD. (See §1869(f)(1)(A)(i) of the Social Security Act.) These instructions should be implemented within your current operating budget. DISCLAIMER: The revision date and transmittal number only apply to the redlined material. All other material was previously published in the manual and is only being reprinted. CMS-Pub.
    [Show full text]
  • Study of Oropharyngeal Ulcers with Their Commonest Anatomical Sites of Presentation Correlated with Histopathological Diagnosis Among the North Bengal Population
    Panacea Journal of Medical Sciences 2020;10(3):258–263 Content available at: https://www.ipinnovative.com/open-access-journals Panacea Journal of Medical Sciences Journal homepage: www.ipinnovative.com Original Research Article Study of oropharyngeal ulcers with their commonest anatomical sites of presentation correlated with histopathological diagnosis among the north Bengal population Tanwi Ghosal (Sen)1, Pallab Kr Saha2,*, Sauris Sen3 1Dept. of Anatomy, North Bengal Medical College, Sushrutanagar, West Bengal, India 2Dept. of Anatomy, NRS Medical College, Kolkata, West Bengal, India 3Dept. of ENT, Jalpaiguri District Hospital, Jalpaiguri, West Bengal, India ARTICLEINFO ABSTRACT Article history: Introduction: Oropharyngeal ulcers are very common in North East part of India due to bad oral habits like Received 31-07-2020 chewing of tobacco etc. A study was performed at North Bengal Medical College and Hospital among the Accepted 06-10-2020 patients attending otorhinolaryngology outdoor to explore the relationship of different types and proportion Available online 29-12-2020 of oropharyngeal ulcers with their commonest anatomical sites and to elicit the relationship with bad oral habits. Aims: • To elicit the different types and proportions of oropharyngeal ulcers. • To explore the relationship Keywords: of different histopathological types with anatomical sites. • To identify the relationship with addiction. Ulcer Material and Methods: This is a Cross-sectional Observational Hospital based study, conducted in the Oral Cavity Otorhinolaryngology outdoor of North Bengal Medical College and Hospital twice a week. 102 patients Oropharynx were selected as study population after maintaining inclusion and exclusion criteria. Anatomical sites Results: The study shows that the most common type of ulcer is aphthous (25.49%) and the least common types are erythroplakia and autoimmune ulcers (1.96%).
    [Show full text]
  • Oral Pigmented Lesions from Brazil
    Med Oral Patol Oral Cir Bucal. 2021 May 1;26 (3):e284-91. Oral pigmented lesions from Brazil Journal section: Oral Medicine and Pathology doi:10.4317/medoral.24168 Publication Types: Research Oral pigmented lesions: a retrospective analysis from Brazil­­­ Danielle Mendes da Silva Albuquerque 1, John Lennon Silva Cunha 2, Ana Luiza Oliveira Corrêa Roza 3, Lady Paola Aristizabal Arboleda 3, Alan Roger Santos-Silva 4, Marcio Ajudarte Lopes 4, Pablo Agustin Vargas 4, Jacks Jorge 4, Oslei Paes de Almeida 4, Aline Corrêa Abrahão 5, Michelle Agostini 5, Mário José Romañach 5, Bruno Augusto Benevenuto de Andrade 5 1 DDS, MSc. Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Brazil 2 DDS, MSc student. Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), SP, Brazil 3 DDS, PhD student. Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), SP, Brazil 4 DDS, PhD. Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), SP, Brazil 5 DDS, PhD. Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Brazil Correspondence: Department of Oral Diagnosis and Pathology Federal University of Rio de Janeiro School of Dentistry Av. Carlos Chagas Filho 373, Prédio do CCS, Bloco K, 2° andar, Sala 56 Ilha da Cidade Universitária, Rio de Janeiro/RJ. 21.941-902 [email protected] Received: 16/07/2020 Albuquerque DMdS, Cunha JLS, Roza ALOC, Arboleda LPA, Santos- Accepted: 24/08/2020 Silva AR, Lopes MA, et al. Oral pigmented lesions: a retrospective analysis from Brazil.
    [Show full text]
  • Oral Manifestations of Systemic Disease Their Clinical Practice
    ARTICLE Oral manifestations of systemic disease ©corbac40/iStock/Getty Plus Images S. R. Porter,1 V. Mercadente2 and S. Fedele3 provide a succinct review of oral mucosal and salivary gland disorders that may arise as a consequence of systemic disease. While the majority of disorders of the mouth are centred upon the focus of therapy; and/or 3) the dominant cause of a lessening of the direct action of plaque, the oral tissues can be subject to change affected person’s quality of life. The oral features that an oral healthcare or damage as a consequence of disease that predominantly affects provider may witness will often be dependent upon the nature of other body systems. Such oral manifestations of systemic disease their clinical practice. For example, specialists of paediatric dentistry can be highly variable in both frequency and presentation. As and orthodontics are likely to encounter the oral features of patients lifespan increases and medical care becomes ever more complex with congenital disease while those specialties allied to disease of and effective it is likely that the numbers of individuals with adulthood may see manifestations of infectious, immunologically- oral manifestations of systemic disease will continue to rise. mediated or malignant disease. The present article aims to provide This article provides a succinct review of oral manifestations a succinct review of the oral manifestations of systemic disease of of systemic disease. It focuses upon oral mucosal and salivary patients likely to attend oral medicine services. The review will focus gland disorders that may arise as a consequence of systemic upon disorders affecting the oral mucosa and salivary glands – as disease.
    [Show full text]
  • Features of Reactive White Lesions of the Oral Mucosa
    Head and Neck Pathology (2019) 13:16–24 https://doi.org/10.1007/s12105-018-0986-3 SPECIAL ISSUE: COLORS AND TEXTURES, A REVIEW OF ORAL MUCOSAL ENTITIES Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa Susan Müller1 Received: 21 September 2018 / Accepted: 2 November 2018 / Published online: 22 January 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. This review will focus exclusively on reactive white oral lesions. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Leukoedema and hereditary genodermatoses that may enter in the clinical differential diagnoses of frictional keratoses including white sponge nevus and hereditary benign intraepithelial dyskeratosis will be reviewed. Many products can result in contact stomatitis. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. Each of these lesions have microscopic findings that can assist in patient management. Keywords Leukoplakia · Frictional keratosis · Smokeless tobacco keratosis · Stomatitis · Leukoedema · Cinnamon Introduction white lesions including infective and non-infective causes will be discussed
    [Show full text]
  • Bullous Pemphigoid/Pemphigus and Administration of the Pfizer/Biontech Vaccine (Comirnaty®). Introduction the Pfizer/Bionte
    Bullous Pemphigoid/Pemphigus and administration of the Pfizer/BioNTech vaccine (Comirnaty®). Introduction The Pfizer/BioNTech vaccine (Comirnaty®) is a COVID-19-mRNA-vaccine (nucleoside modified). It is indicated for active immunisation to prevent COVID-19 caused by SARS-CoV-2 virus, in individuals 16 years of age and older. [1] The nucleoside-modified messenger RNA in Comirnaty® is formulated in lipid nanoparticles, which enable delivery of the nonreplicating RNA into host cells to direct transient expression of the SARS-CoV-2 S antigen. The mRNA codes for membrane-anchored, full-length Spike glycoprotein with two point mutations within the central helix. [1] Comirnaty® has been registered in Europe since December 21st, 2020. Bullous skin diseases are a group of dermatoses characterized by blisters and bullae in the skin and mucous membranes. The most common are pemphigus and bullous pemphigoid (BP). Pemphigus and bullous pemphigoid are autoantibody-mediated blistering skin diseases. In pemphigus, keratinocytes in epidermis and mucous membranes lose cell-cell adhesion, and in pemphigoid, the basal keratinocytes lose adhesion to the basement membrane. Bullous pemphigoid is a more common disease than pemphigus [2]. Bullous pemphigoid is the most common heterogeneous subepidermal autoimmune blistering disease (incidence 7 per million person year) [3,4], with an increasing prevalence after the age of 70, although it can also occur in the younger. It is characterized by auto-antibodies against different structural proteins of the hemidesmosomes in the epidermal basement membrane zone (EBMZ). Bullous pemphigoid typically causes severe pruritus with predominantly cutaneous lesions consisting of tense (fluid filled) bullae, erythema, and urticarial plaques.
    [Show full text]
  • Paraneoplastic Pemphigus with Clinical Features of Lichen Planus Associated with Low-Grade B Cell Lymphoma
    Report Paraneoplastic pemphigus with clinical features of lichen planus associated with low-grade B cell lymphoma Sónia Coelho, MD, José Pedro Reis, MD, Oscar Tellechea, MD, PhD, Américo Figueiredo, MD, PhD, and Martin Black, MD, PhD From the Department of Dermatology, Abstract University Hospital, Coimbra, Portugal, St Background Neoplasia-induced lichen planus is described as a cell-mediated reaction to John’s Institute of Dermatology, St Thomas’ unknown epithelial antigens. Paraneoplastic pemphigus (PNP), characterized by the presence Hospital, London, UK of a specific array of autoantibodies, probably represents a different form of presentation of the Correspondence same autoimmune syndrome where the mucocutaneous expression depends on the dominant Sónia Coelho pathologic mechanism. Clínica de Dermatologia, Hospital da Methods The authors report a case of PNP with predominant lichen planus-like lesions and Universidade review the relevant literature. We observed a 74-year-old female with vesico-bullous, erosive, P.3000–075 Coimbra target-shaped and flat papular lichenoid lesions on the lower legs, palms and soles, evolving for Portugal E-mail: [email protected] 3 weeks. Histopathology revealed a lichenoid dermatitis. Direct immunofluorescence showed C3 deposition around keratinocytes and epidermal IgG intranuclear deposition. Indirect immunofluorescence revealed circulating IgG with intercellular staining on rat bladder substrate. Immunoblotting demonstrated bands of 130, 190, 210 and 250 kDa antigens. A pararenal B cell lymphoma was found. Results Oral corticotherapy with 40 mg prednisolone daily was initiated with a good cutaneous response. Four months later, cyclophosphamide (50 mg/day) was introduced because of a discrete enlargement of the pararenal mass. The patient died on the seventh month of follow up as a result of respiratory insufficiency.
    [Show full text]
  • Amalgam Pigmentation) on the Palatal Mucosa: a Case Report
    Open Access Journal of Dentistry & Oral Disorders Case Report Extensive Amalgam Tattoo (Amalgam Pigmentation) on the Palatal Mucosa: A Case Report Fiqhi MK1*, Essaoudi MA2, Khalfi 1L and Khatib KE1 Abstract 1 Department of Plastic, Maxillofacial and Oral Surgery, Introduction: Amalgam tattoo is the most common exogenous oral Mohammed V Military Teaching Hospital, Rabat, pigmentation, caused by traumatic implantation of dental amalgam into soft Morocco tissue. 2Department of Anatomic Pathology, Mohammed V Military Teaching Hospital, Rabat, Morocco Observation: We report a case of large amalgam pigmentation on right hard palate. *Corresponding author: Fiqhi Mohammed Kamal, Department of Plastic, Maxillofacial and Oral Surgery, Discussion: Amalgam tattoo can sometimes be confused with melanotic Mohammed V Military Teaching Hospital, Rabat, lesions, being then biopsied. Once the diagnosis of amalgam tattoos has been Morocco established, the removal of lesions is not necessary, except for esthetic reasons. Received: March 02, 2018; Accepted: April 03, 2018; Keywords: Amalgam tattoo; Oral mucosa; Pigmentation Published: April 10, 2018 Introduction Oral pigmentations may be classified into two major groups on the basis of their clinical appearance: focal and diffuse pigmentations. All pigmented oral cavity lesions should be viewed with suspicion to eliminate a malignant melanoma. This article deals with an extensive amalgam tattoo lesion on palatal mucosa which required a biopsy for a definitive diagnosis. Case Presentation A 56-year-old man with an unremarkable medical history was referred to the department of maxillofacial surgery on suspicion of mucosal melanoma. Clinical examination found a large brown flat macula located on the right hard palate adjacent to a restored tooth 16 with presence of amalgam fillings (Figure 1).
    [Show full text]