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Oral Pathology - 06 - Mucosal Malignant Lesions

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Oral Pathology1

Table Of Contents

Clinical Categories and Disease Classifications2

  • Developmental Conditions
  • Mucosal Lesions—Reactive
  • Mucosal Lesions—Infections
  • Mucosal Lesions—Immunologic Diseases
  • Mucosal Lesions—Premalignant
  • Mucosal Lesions—Malignant
  • CT Tumors—Benign
  • CT Tumors—Malignant
  • Salivary Gland Diseases—Reactive
  • Salivary Gland Diseases—Benign
  • Salivary Gland Diseases—Malignant
  • Lymphoid Neoplasms
  • Odontogenic Cysts
  • Odontogenic Tumors
  • Bone Lesions—Fibro-Osseous
  • Bone Lesions—Giant Cell
  • Bone Lesions—Inflammatory
  • Bone Lesions—Malignant
  • Hereditary Conditions

General Principles Of Oncology

Clinical Presentation

Most cancers manifest as non-painful and non-healing indurated ulcers. Induration is a key clinical component for most of the cancers discussed.

High-Risk Sites:

  • Floor of the mouth (Number one high-risk site)
  • Posterior lateral tongue (Number two high-risk site)

Classification Of Cancer Types3

Cancers are classified based on the tissue of origin:

  • Carcinoma: Originates from epithelial tissue
  • Sarcoma: Originates from mesenchymal (connective) tissue
  • Leukemia: Originates from blood-forming tissues
  • Lymphoma: Originates from the lymphatic system

Stages Of Cancer Progression4

The progression of cancer typically follows these stages:

  • Dysplasia: Pre-cancerous changes.
  • Carcinoma in situ: A state where the entire thickness of the epithelium is affected, but the basement membrane remains intact.
  • Malignant neoplasm: Defined as cancer once it invades past the basement membrane.
    • Local invasion: Extension into the underlying connective tissue.
    • Metastasis: Gaining access to blood or lymph vessels to travel to distant sites in the body
  • TNM Staging: A system used to describe the stage of tumor invasion (T), node involvement (N), and the presence of metastasis (M)..

Malignant Mucosal Lesions

Verrucous Carcinoma

Etiology and Characteristics5

  • Tobacco use and HPV 16 and 18 are primary causes.
  • Can arise from proliferative verrucous leukoplakia.
  • Characterized as a slow-growing malignancy.

Snuff Dipper's Carcinoma

Verrucous carcinoma is sometimes referred to as "snuff dipper's carcinoma."

Treatment

  • Treatment involves surgical excision.

Squamous Cell Carcinoma

Pathogenesis and Risk Factors6

  • Caused by the activation of oncogenes or the inactivation of tumor suppressor genes.
  • There is an increased incidence of oropharyngeal SCC associated with HPV 16 and 18.
  • Plummer-Vinson Syndrome: A condition characterized by mucosal atrophy, dysphagia, and iron deficiency anemia; it is associated with an increased risk of oral cancer
    • Mucosal atrophy often presents as an atrophic tongue.

Prognosis and Treatment

  • The 5-year survival rate is approximately 50%.
  • Treatment options include surgical excision or radiation therapy.

Basal Cell Carcinoma7

  • Etiology: Primarily due to sun damage.
  • Behavior: Very rarely metastasizes.
  • Considered one of the least dangerous types of cancer.
  • Treatment: Managed through surgery.

Oral Melanoma

Clinical Features8

  • A malignancy of the melanocytes.
  • Typically presents with a dark, purplish-black appearance.
  • High-risk sites for occurrence include the palate and the gingiva.

Prognosis

  • The 5-year survival rate for skin lesions is greater than 65%.
  • The 5-year survival rate for oral lesions is significantly lower, at less than 20%.

Footnotes

  1. Original PDF page 1: Oral Pathology - 06 - Mucosal Malignant Lesions, p.1 ↩

  2. Original PDF page 2: Oral Pathology - 06 - Mucosal Malignant Lesions, p.2 ↩

  3. Original PDF page 3: Oral Pathology - 06 - Mucosal Malignant Lesions, p.3 ↩

  4. Original PDF page 4: Oral Pathology - 06 - Mucosal Malignant Lesions, p.4 ↩

  5. Original PDF page 5: Oral Pathology - 06 - Mucosal Malignant Lesions, p.5 ↩

  6. Original PDF page 6: Oral Pathology - 06 - Mucosal Malignant Lesions, p.6 ↩

  7. Original PDF page 7: Oral Pathology - 06 - Mucosal Malignant Lesions, p.7 ↩

  8. Original PDF page 8: Oral Pathology - 06 - Mucosal Malignant Lesions, p.8 ↩

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