Classification of Soft Tissue Lesions PDF

Oral lesions:  1- Ulcerative, Vesicular, and Bullous Lesions  2- Pigmented Lesions of the Oral Mucosa  3- Exophytic oral lesions: - Hard/ firm, non-bleeding lesions - Soft formation with tendency to bleed -Tight-elastic formations  Ulcerative...

Oral lesions:  1- Ulcerative, Vesicular, and Bullous Lesions  2- Pigmented Lesions of the Oral Mucosa  3- Exophytic oral lesions: - Hard/ firm, non-bleeding lesions - Soft formation with tendency to bleed -Tight-elastic formations  Ulcerative, Vesicular, and Bullous Lesions Multiple Single Acute Chronic -Herpes Simplex Virus Infections -Traumatic Injuries Causing -Varicella Zoster Virus (VZV) Solitary Ulcerations Infection -Cytomegalovirus (CMV) Infection -Pemphigus Vulgaris (PV) -Traumatic Ulcerative -Epstein-Barr Virus Infection -Paraneoplastic Pemphigus (PNP) Granuloma (Eosinophilic Ulcer -Coxsackievirus Infection -Subepithelial Bullous Disorders of Tongue) -Necrotizing Ulcerative Gingivitis -Bullous Pemphigoid (BP) - Infectious Ulcers and Periodontitis -Mucous Membrane Pemphigoid - Histoplasmosis -Erythema Multiforme -Linear IgA Disease (LAD) - Blastomycosis -Stevens-Johnson Syndrome (SJS) -Epidermolysis Bullosa and Toxic Epidermal Necrolysis (TENs) -Plasma Cell Stomatitis and Oral Hypersensitivity Reactions Recurrent Aphthous ulcers Herpes Simplex Virus Infection -Herpes simplex virus (HSV)‐1 Primary herpetic gingivostomatitis Secondary or recrudescent herpetic lesions  Primary herpetic gingivostomatitis: Oral Findings Erythema and clusters of vesicles and/or ulcers appear on: - The keratinized mucosa of the hard palatal mucosa, attached gingiva and dorsum of the tongue. And - The nonkeratinized mucosa of the buccal and labial mucosa, ventral tongue, and soft palate.  Recrudescent Oral HSV Infection Recurrent herpes labialis (RHL) Recrudescent intraoral HSV (RIH) These are associated with a prodrome of occurs chiefly on the keratinized mucosa itching, tingling, or burning of the hard palatal mucosa, attached approximately 50% of the time, followed gingiva, and dorsum of the tongue. in succession by the appearance of papules, vesicles, ulcers, crusting, and They present as 1 to 5 mm single or then resolution of lesions clustered painful ulcers with a bright erythematous border Varicella Zoster Virus (VZV) Infection Primary infection with VZV (Chickenpox) Oral Manifestation Site: Small blister like-lesions occasionally involve the oral mucosa, tongue, gingiva, palate as well as mucosa of pharynx which ruptures to form minor acute ulceration Appearance: the mucosal lesion, initially a slight raised vesicle with a surrounding erythema, ruptures soon after formation and forms a small eroded ulcer with red margins, closely resembling aphthous lesions. Recurrent VZV infection (Herpes Zoster) It is also called as ‘shingles’ Oral Manifestations Involvement of second division leads to lesion of midface and upper lip and involvement of third division leads to lesion of lower face and lower lip, mandibular gingiva and tongue. Site: It may be found in buccal mucosa, tongue, uvula, pharynx and larynx Symptoms: Patient notice pain, burning, tenderness usually on the palate on one side Signs: After several days of symptoms, intact vesicles appear which soon rupture to leave areas of erosion or ulcers of 1–5 mm size  Coxsackievirus Infection Herpangina Hand, Foot and Mouth Disease The first oral symptoms are: Patients are febrile and complain of a sore mouth sore throat and pain on swallowing. There and throat. may be erythema of the oropharynx, soft Lesions begin as erythematous macules that become palate, and tonsillar pillars. Small vesicles vesicles and quickly break down to ulcers. form, but these rapidly break down to 2 to 4 mm ulcers and these persist for 5 to 10 Lesions are usually located on the tongue, hard days. and soft palate, and buccal mucosa but can present on any oral mucosal surface.  Erythema Multiforme Erythema multiforme (EM) is an acute, self‐limited, inflammatory mucocutaneous disease that manifests on the skin and often oral mucosa. Oral Findings -The oral findings in EM range from mild erythema and erosion to large painful ulcerations. -When severe, ulcers may be large and confluent, causing difficulty in eating, drinking, and swallowing, and patients with severe EM may drool blood‐tinged saliva. Extensive lip involvement with inflammation, ulceration, and crusting is common. - Sites: The most commonly affected sites are the lips, buccal mucosa, tongue , and labial mucosa. Stevens‐Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TENs) Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are both rare severe necrolytic mucocutaneous disorders resulting from hypersensitivity to medications and are clinically and etiopathogenetically distinct from EM. The typical oral manifestation is hemorrhagic crusts on the vermilion and extensive ulcerations and erythema on the oral and other mucosal surfaces  Necrotizing Ulcerative Gingivitis and Periodontitis Oral Manifestations NUG has a rapid and acute onset. The first symptoms include excessive salivation, a metallic taste, and sensitivity of the gingiva. This rapidly develops into extremely painful and erythematous gingiva with scattered punched‐out ulcerations, usually on the interdental papillae, although any part of the marginal gingiva may be affected.  Plasma Cell Stomatitis and Oral Hypersensitivity Reactions It presents as brightly erythematous macular areas of the oral cavity, almost always involving the marginal and attached gingiva or alveolar mucosa and often involving other soft tissues, such as the maxillary and mandibular sulcus, tongue, or buccal mucosa. Ulcers may be present, and there may be epithelial sloughing and desquamation. The gingiva may also be swollen and edematous. Patients may complain of pain and sensitivity and bleeding of the gingiva on brushing.  Recurrent Aphthous Stomatitis (RAS) The lesions are confined to the oral mucosa and begin with prodromal burning from 2 to 48 hours before an ulcer appears. During this initial period, a localized area of erythema develops. Within hours, a small white papule forms, ulcerates, and gradually enlarges over the next 48–72 hours. The individual lesions are round- to ovoid, symmetric, and shallow. Multiple lesions are often present The buccal and labial mucosae are most commonly involved. Lesions rarely occur on the heavily keratinized palatal mucosa or gingiva. Pemphigus Vulgaris (PV) in 60% of cases, oral lesions are the first sign. It is common for the oral lesions to be present for weeks to months before the skin lesions appear. Pemphigus vulgaris presents as flaccid, thin-walled vesicles and/or bullae, varying in diameter from few millimeters to several centimeters arise on normal skin or mucosa that usually rupture to leave an area of erosion and ulceration Most commonly, lesions start on the buccal mucosa, often in areas of trauma along the occlusal plane. The palatal mucosa, tongue, and gingiva are other common sites of Involvement. Didona, D., Maglie, R., Eming, R., & Hertl, M. (2019). Pemphigus: current and future therapeutic strategies. Frontiers in immunology, 10, 1418. Bullous Pemphigoid (BP) BP is the most common autoimmune subepidermal blistering skin disease. It occurs mainly in adults over the age of 60 years and may last from a few months to several years. Oral Findings Oral involvement occurs in 10% to 20% of BP patients. The oral lesions of BP are smaller, form more slowly, and are less painful than those seen in PV. Sites: Localized or scattered vesicles or bullae occur and ultimately erosion may develop not only on the attached gingival tissue but any other area such as the buccal mucosa, floor of the mouth and tongue  Mucous Membrane Pemphigoid [MMP] Oral Findings Oral lesions occur in 85% of patients with MMP. Intraoral sites include the gingiva , buccal mucosa, palate , alveolar ridge , tongue, and lower lip. Desquamative gingivitis may occur alone or in addition to other intraoral sites. It typically manifests as erythema of the attached gingiva with or without blistering and ulceration. It may be localized or generalized. Lesions elsewhere may present as patches of erythema, intact blisters, or ulcers with a yellow base and well‐defined margin. Traumatic Ulcerative One of the most common cause of oral ulceration is trauma. Etiology Mechanical or physical trauma: Lip, cheek or tongue biting, sharp or malposed teeth or roots, toothbrush injury, sharp margins of restorations or prostheses, ill-fitting dentures. Chemical trauma: Caustic substances such as silvernitrate, phenol, formocresol, eugenol, eucalyptus oil, phosphorus and acetylsalicylic acid can cause oral ulceration. Substance abuse such as with the use of powder cocaine or smoking crack cocaine has also been reported to cause oral ulceration Thermal trauma: Excessive heat from hot liquids and food can cause mucosal burn and ulceration. On rare occasion, the application of the dry ice and hot instrumentation also causes ulcers Symptoms: There is tenderness and pain in the area of lesion which may help in identifying the cause of lesion. It may persist for few days and may last for weeks. Size and shape: The most common variety of traumatic ulcer is single uncomplicated ulcer. It is of moderate size (from several millimeters to a centimeter or more in diameter). Shape of ulcer is usually round, oval or elliptical in shape and flat or slightly depressed Infectious Ulcers Secondary Syphilis: Site: It is found on tongue, buccal mucosa, tonsillar and pharyngeal region, and lips. Snail track ulcers: Confluence and coalescence of the glistening mucous patches give rise to the so called ‘snail track ulcers’ – Symptoms: It is often painless, but sometimes mild to moderately painful  Tuberculosis Oral Manifestations Site: Tongue is most commonly affected followed by palate, lips, buccal mucosa and gingiva Primary oral lesion: It develops when bacteria is directly inoculated in the oral tissue of a person who has not acquired immunity to the disease. It involves gingiva, tooth extraction socket and buccal fold Secondary oral lesion: Infection is carried by hematogenous route or through break in the tissue surface, is deposited in the submucosa, subsequently proliferates and ulcerates the overlying mucosa. It occurs more frequently in cases of extrapulmonary tuberculosis  Pigmented Lesions of the Oral Mucosa FOCAL MELANOCYTIC MULTIFOCAL/DIFFUSE PIGMENTATION PIGMENTATION -Physiologic Pigmentation -Freckles/Ephelis -Drug‐Induced Melanosis -Oral/Labial Melanotic Macule -Smoker’s Melanosis -Oral Melanoacanthoma -Post-inflammatory (Inflammatory) - -Melanocytic Nevus Hyperpigmentation -Malignant Melanoma -Melasma (Chloasma) -Amalgam tattoo, -Kaposi’s sarcoma -Graphite tattoo -Hereditary hemorrhagic telangiectasia -Nevus -Melanosis Associated With systemic or genetic Disease  Freckles/Ephelis -It is asymptomatic, well‐circumscribed, tan‐ or brown‐colored macules often seen on sun ‐exposed regions of the skin -Most commonly observed in light‐skinned individuals and are quite prevalent in red‐ or light blond‐haired individuals In general, no therapeutic intervention is required  Oral/Labial Melanotic Macule The melanotic macule is a unique, benign, pigmented lesion. Oral manifestation: Melanotic macules develop more frequently in females, usually in the lower lip (labial melanotic macule) and gingiva. Shape: Small (