White Lesion思维导图

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2024-05-29

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Leukoedema

Uniform opacification of buccal mucosal bilaterally

Unknown cause; more common in smoker

Disappear when mucosa stretched

No Tx needed

-Increased thickness of epithelium-intercellular edema of spinous layer -Vacuolated cells large and have pyknotic nuclei

White Sponge nevus (Cannon Disease)

Asymptomatic, symmetrical, thickened, white, corrugated or velvety, diffuse plaques affect the buccal mucosa in most instances;

Heraditary; AD; Mutations in either Keratin 4 and/or 13 genes

Appear at birth or early childhood; No Tx needed

Asymptomatic, thick, whitecorrugated plaque; Bilaterally on buccal mucosa

-hyperkeratosis -Acanthosis -Clearing of cytoplasm in spinou cell layer -Perinuclear eosinophilic condensation

Hereditary Benign intraepithelial dyskeratosis (Witkop-Sallmann Syndrome)

Asymptomatic, diffuse, shaggy white lesions of buccal mucosa; EYE lesions - white plaques surrounded by inflamed conjuctiva

Hereditary; AD; Duplication of chromosome 4q35

Primary affect descendants of triracial isolate of people who in North Carolina; appear childhood

Ocular lesion early in life; thick opaque gelatinous plaques; affect bulbar conjunctiva

when lesion active, experience tearing, itching and photophobia

syptomatic ocular lesion should referred to ophthalmologist

Oral lesions like those of white sponge nevus

No Tx on oral lesion

Frictional hyperkeratosis

Asymptomatic, diffuse, white plaque; edentulous ridge, buccal mucosa and tongue; poorly defined borders; not rub off

Chronic irritation

May regress if cause is eliminated

Cheek Chewing

Lip Chewing

Tongue Chewing

Linea Alba (frictional Keratosis); A white line seen on buccal mucosa due to friction of teeth with buccal mucosa

Smokeless Tobacco Keratosis (Snuff Dipper's Lesion)

Asymptomatic white or grey, soft and velvety plaque involving mucosa in direct contact with the snuff or chewing tobacco; indistinct border; usually found in labial and buccal vestibule; flaccid mucosa

Chronic irritation from snuff or chewing tobacco

Takes 1-5 years to develop; completely reversible; Increased risk of development of Verrucous Ca and SCCa after many years

Soft, fissured, grey-white plaque; poorly defined; induration, ulceration, and pain are not present

-Severity of defect correlated with the quantity and duration of smokeless tobacco use -Biopsy indicated for lesions with atypical findings -Habit cessation leads to normal mucosal appearance (usually within 2 weeks) in 98% of cases -For patients unable to cease the habit, switching to a different tobacco-chewing site is recommended

Lesions that remain after two weeks of cessation should be biopsied!!!

Nicotine Stomatitis (Smokers Palate)

Palatial mucosa is diffusely grey or white with numerous slightly elevated papules with punctate red centers

Develops in response to heat rather than the chemicals in tobacco smoke

Does not appear to have a premalignant nature; completely reversible;

-Palatal Mucosa is diffusely grey or white with numerous slightly elevated papules with punctate red centers -These papules represent inflamed minor salivary glands and their ductal orifices -Palatal lesion associated with reverse smoking; well-defined reddening of the palatal mucosa (premalignant)

Actinic cheilitis

Lower lip

Chronic UV light exposure

Common premalignant alteration of the lower lip vermillion; May result in SCCa

-Seldom occurs in patients younger than 45 years -Lesions develop slowly -Early clinical finding: atrophy (smooth blotchy pale areas), dryness, and fissures of the lower lip with blurring of the margins between vermillion and adjacent skin

-As lesions progress, rough scaly areas develop -Eventually, chronic ulcerations may develop , and may suggest progression to squamous cell carcinoma

Hairy Tongue

Marked accumulation of keratin on filiform papillae of dorsal tongue; Yellow, brown or black; affects midline, sparing lateral and anterior borders

Uncertain; many affected are heavy smokers

Benign process; may be cosmetically objectable

-Accumulation of keratin on filiform papillae on the dorsal surface of tongue-Many affected people are heavy smokers -Other possible associations: poor oral hygiene, general debilitation, xerostomia inducing drugs, and history of radiation therapy to head and neck

Geographic Tongue (Erythema Migrans)

Multiple well-demarcates zones of erythema (due to atrophy of filiform papillae), surrounded at least partially by elevated yellow-white line.

Unknown

Completely benign; spontaneous regression after months to years

-Typically seen on the anterior 2/3rd of the dorsal tongue mucosa; rarely on other sites -Appears quickly in one area, healing within a few days or weeks, and then develops in a very different area -Usually asymptomatic -May cause a burning to hot and spicy foods -Rarely is the burning sensation severe and constant; -topical corticosteroids (betamethasone) rovides relief -2/3rd patient have a fissured tongue

Dentifrice associated slough (Oral Mucosal Peeling)

Asymptomatic, slough of flimsy parakeratotic cells

Mucosal reaction to components in toothpaste (sodium lauryl sulphate)

-Most frequently involved areas: oral vestibule, buccal mucosa and gingiva -Evolution time is quite variable, from 3 days to 10 years, depending on the exposition to the causal agent

Mucosal Burns

Painful white fibrin exudate covering superficial ulcer with erythematous ring; common

Chemical (aspirin, phenol), heat, electric burns

Heals in days to weeks

Chemical Burn -Large ulcer following improper use of bisphosphonate (Alandronate) & Formalin

Thermal Burns

Electric Burn -Areas of yellow-white epithelial necrosis and areas of erythema

Oral Hairy Leukoplakia

White mucosal plaque that does not rub off; Most cases on lateral borders of tongue; vary from faint, white vertical streaks to thickened, furrowed areas of leukoplakia with a shaggy surface; infrequently cover dorsal tongue

Epstein-Barr viral infection in patients with AIDS May also occur in immunosuppressed patients

Development may indicate: 1. disease progression, 2. lack of compliance to ART, or 3. retroviral drug resistance Treatment not needed; Systemic anti-retroviral drugs produce resolution

HIV-associated OHL; vertical streaks of keratin along the lateral border of tongue

Idiopathic Leukoplakia

Asymptomatic white patch; cannot be wiped off; > males

Unknown; may be related to tobacco or alcohol use

May recur after excision; 5% are malignant; higher risk of carcinoma if dysplasia present

1. Mild epithelial dysplasia: alterations limited principally to the basal and parabasal layers 2. Moderate epithelial dysplasia: alterations from the basal layer to the midportions of the epithelial layer 3. Severe epithelial dysplasia: alterations from the basal layer to the level above the midpoint of the epithelium

Early, thin and homogenous leukoplakia Well-defined, thin, white plaque

Homogenous and thick leukoplakia Well-defined, thick, white plaque

Granular Leukoplakia Granular Erythroleukoplakia

Verrucous Leukoplakia Keratotic plaques with rough surface projections

Proliferative Verrucous leukoplakia Extensive leukoplakia with rough surface projections; the plaques proliferate

Lichen Planus

Middle aged adults; -Skin lesions: purple, pruritic, polygonal plaques (4Ps) -Reticular LP: posterior buccal mucosa, bilaterally; asymptomatic; interlacing white -Erosive LP: symptomatic; atrophic, erythematous areas with central ulcerations of various degrees; periphery of atrophic region bordered by interlacing white lines -Desquamative gingivitis: atrophy and ulceration confined to gingiva

Unknown; hyperimmune condition mediated by T-cells

Diagnosis of LP -Reticular LP: based on clinical findings alone -Erosive LP: sometimes challenging; Diagnosis confirmed by direct immunofluorescent examination of paralesional tissue submitted in Michel's solution -Most lesions show the deposition of a shaggy band of fibrinogen at the basement membrane zone

May regress after many years; treatment may only control disease; the question of malignant potential still not resolved; rare malignant transformation Relationship to stress and anxiety is controversial; recent studies show a link with hypothyroidism

Cutaneous Lichen Planus Purple, polygonal papules

Reticular Lichen Planus Interlacing white lines involving buccal mucosa, bilaterally

Erosive Lichen Planus Ulcerations, with peripheral radiating white lines

Desquamative gingivitis When atrophy and ulcerations are confined to the gingival mucosa

Pseudomembranous Candidiasis (Thrush)

Adherent white plaques that resemble cottage cheese or curdled milk on the oral surface; can be wiped off; underlying mucosa may appear normal or edematous Symptoms: burning sensation, and an unpleasant taste

Opportunistic fungus; initiated by exposure of patient to broad-spectrum antibiotics or use of topical corticosteroids; immunosuppression

Antifungal medications; Usually disappears in 1-2 weeks after treatment; Some chronic cases require long term therapy

White plaques on an erythematous base; can be wiped off with a wet gauze

Fordyce granules

Multiple, yellow or yellow-white papules; asymptomatic; seen primarily in buccal mucosa and lips; variation of normal (80% of population)

Developmental

Ectopic sebaceous glands (Choristoma) of no significance

Yellow papules; asymptomatic

Lymphoid hyperplasia

Asymptomatic, smooth surfaced papules or elevated-yellow nodule; <0.5 cm in diameter; usually found on tonsillar pillars, posterolateral tongue and floor of mouth; covered by intact epithelium; common

Developmental

No significance; lesions remain indefinitely and are usually diagnostic clinically

Palatal lymphoid hyperplasia: Smooth surfaced pink or yellowish papules Large tonsils; if significant asymmetry is observed, further investigations may be warranted to rule out possibility of lymphoma or other malignancy

Lingual Tonsil Smooth-surfaced papule of the posterior lateral tongue represents an enlarged lymphoid aggregate