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Questions and Answers
A patient presents with a persistent oral ulcer that has been present for 4 weeks, along with white and red patches. What is the MOST appropriate next step in managing this patient?
A patient presents with a persistent oral ulcer that has been present for 4 weeks, along with white and red patches. What is the MOST appropriate next step in managing this patient?
- Monitor the lesion for another 3 weeks before considering further intervention.
- Refer the patient for a biopsy to determine the presence of dysplasia or carcinoma. (correct)
- Prescribe a broad-spectrum antibiotic to rule out bacterial infection.
- Advise the patient to use an over-the-counter antiseptic mouthwash.
What is the PRIMARY diagnostic criterion for leukoplakia?
What is the PRIMARY diagnostic criterion for leukoplakia?
- Observation of distinct keratin pearl formation under microscopic examination.
- Exclusion of other identifiable causes after clinical and histopathological examination. (correct)
- Identification of specific viral DNA sequences within the lesion.
- Positive response to antifungal medication, indicating a fungal etiology.
Which variant of leukoplakia is characterized by a wart-like texture?
Which variant of leukoplakia is characterized by a wart-like texture?
- Homogeneous
- Speckled
- Verrucous (correct)
- Nodular
What is the MOST critical management strategy for proliferative verrucous leukoplakia (PVL)?
What is the MOST critical management strategy for proliferative verrucous leukoplakia (PVL)?
Speckled leukoplakia is BEST described as:
Speckled leukoplakia is BEST described as:
What is the PRIMARY risk associated with reverse smoking?
What is the PRIMARY risk associated with reverse smoking?
In regions where reverse smoking is prevalent, which oral site is MOST commonly affected and carries the highest risk of malignant transformation?
In regions where reverse smoking is prevalent, which oral site is MOST commonly affected and carries the highest risk of malignant transformation?
What is the MOST specific clinical characteristic of smokeless tobacco-induced keratoses?
What is the MOST specific clinical characteristic of smokeless tobacco-induced keratoses?
Flashcards
Persistent Ulcers
Persistent Ulcers
Ulcers in the mouth lasting for 3 weeks or more.
Leukoplakia
Leukoplakia
White plaques in the mouth, diagnosed after clinical examination and biopsy.
Homogeneous Leukoplakia
Homogeneous Leukoplakia
Flat, thin white lesions with shallow surface cracks.
Speckled Leukoplakia
Speckled Leukoplakia
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Reverse Smoking
Reverse Smoking
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Tobacco-Induced Keratoses
Tobacco-Induced Keratoses
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Proliferative Verrucous Leukoplakia (PVL)
Proliferative Verrucous Leukoplakia (PVL)
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Erythroplakia
Erythroplakia
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Study Notes
Oral Premalignancy: Clinical Appearances
- Common symptoms include persistent ulcers (≥3 weeks), red/white patches, and unusual lumps/swellings.
- Approximately 6,000 new cases annually in the UK, with 80% unaware of symptoms.
Leukoplakia
- Definition: White plaques of questionable risk; diagnosed by exclusion after clinical exam and biopsy.
- Histology: No specific histology, clinico-pathological diagnosis.
- Clinical Variants:
- Homogeneous: Flat, thin, with surface cracks.
- Non-Homogeneous:
- Speckled: Mixed red and white patches.
- Nodular: Raised lesions.
- Verrucous: Wart-like texture.
- Proliferative Verrucous Leukoplakia (PVL):
- High-risk presentation in females >55, often non-smokers.
- Multiple white lesions progressing to squamous carcinoma.
- Recurrence and multiple carcinomas common.
- Management: Regular biopsy and monitoring.
Speckled Leukoplakia
- Definition: Lesions with red and white areas (white flecks/nodules on erythematous base).
- Clinical Features: Combination of leukoplakia and erythroplakia.
- Higher dysplasia prevalence than pure white lesions.
- Intermediate histological features between leukoplakia and erythroplakia.
Reverse Smoking
- Definition: Placing the lit end of a cigarette/cigar in the mouth.
- Effects: Chronic irritation and inflammation of oral tissues, commonly affecting the hard palate, causing speckled changes (red/white patches).
- Increases risk of pre-malignant/malignant lesions (erythroplakia, squamous cell carcinoma).
- Risk Factors: Prevalent in regions with cultural/habitual practice.
- Clinical Significance: Hard palate lesions have a high risk of malignant transformation; early detection and cessation crucial.
Smokeless Tobacco-Induced Keratoses
- Etiology: Tobacco application to mucosa induces hyperkeratosis and inflammation.
- Clinical Features: Lesions limited to the site of application; extensive thickening/wrinkling with prolonged use.
- Risk of squamous carcinoma; snuff dippers develop verrucous carcinoma.
- Habit cessation can lead to lesion resolution in non-dysplastic cases.
- Management: Habit cessation; regular follow-up and biopsy for high-risk lesions; education on risks.
Lichen Planus
- Prevalence: Common, unknown etiology.
- Clinical Features: White patches/striae, bilateral and symmetrical.
- Six subtypes: Reticular, Papular, Plaque-like, Atrophic, Erosive, Bullous (rare).
- Patterns often coexist and evolve.
- Risk of Malignancy: Transformation rate unspecified.
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