THE UNIVERSITY OF WESTERN AUSTRALIA SEEK WISDOM Benign epithelial pathosis Dr Agnieszka Frydrych  Dr Agnieszka Frydrych A close-up medical photograph showing a red, inflamed tissue with multiple small, raised nodules, likely representing a benign epithelial lesion. The image is labeled with the name 'Dr Agnieszka Frydrych' at the bottom. # **Why is this important?** * **Common problems** * **Important to recognize and manage appropriately** $\rightarrow$ **Why?**  #### Clinical Significance - Common problems encountered in practice - Importance of accurate recognition and appropriate management A speaker icon with sound waves, indicating audio or sound, located in the bottom right corner of the slide. **Why is this important?** <br> <img src="image1.jpg" alt="Image of a worried-looking man in a suit biting his nails while looking at a red telephone, next to an image of inflamed tonsils.">   #### Clinical Significance Visual representation of patient anxiety and clinical presentation (inflamed tonsils) related to benign epithelial pathosis. A close-up photo of inflamed tonsils, showing redness and swelling, placed next to an image of a worried-looking man in a suit biting his nails while looking at a red telephone. The photo illustrates the physical symptoms of tonsillitis, which may cause anxiety or concern. A photo of a man in a suit with glasses, appearing anxious as he bites his nails while looking at a red telephone. This image is used to convey stress or worry, possibly related to a medical condition like tonsillitis, which is illustrated in the adjacent inset photo. **Why is this important?**  #### Clinical Significance A photo showing a long line of people standing in a queue, viewed from behind, with the text "Why is this important?" displayed above. The individuals are dressed in casual attire, and the scene appears to be set outdoors against a plain wall, suggesting a waiting scenario for an event or service. # **Leukoedema** * **Aetiology and pathogenesis** * Generalized mild opacification of oral mucosa * Common #### Aetiology and Pathogenesis - Generalized mild opacification of the oral mucosa. - This is a common condition. # **Leukoedema** * **Clinical features** * $\rightarrow$ Incidental finding * $\rightarrow$ Asymptomatic and symmetrically distributed   #### Clinical Features - Typically an incidental finding during examination. - Asymptomatic and symmetrically distributed. Close-up photograph of the oral cavity showing leukoedema, characterized by a diffuse white or grayish patch on the buccal mucosa, consistent with the clinical features described as an incidental finding and symmetrically distributed. Another close-up photograph of the oral cavity illustrating leukoedema, with a similar white patch on the buccal mucosa, reinforcing the asymptomatic and symmetric nature of the condition as noted in the text. Leukoedema Photos courtesy of Dr JE Bouquot   Clinical photographic documentation of Leukoedema (Photos courtesy of Dr. JE Bouquot). A close-up photo of a dental examination showing a tooth with a dark filling and surrounding oral tissue, illustrating leukoedema with a white, cloudy appearance on the mucosa. A second photo showing another view of the oral cavity with leukoedema, characterized by a diffuse white, wrinkled appearance on the buccal mucosa, with a dental instrument visible. # **Leukoedema** * **Histopathology** * $\rightarrow$ Epithelium is parakeratotic and acanthotic * $\rightarrow$ Intracellular oedema * $\rightarrow$ Pyknotic nuclei   #### Histopathology - The epithelium exhibits parakeratosis and acanthosis. - Presence of intracellular oedema. - Observation of pyknotic nuclei. Microscopic image labeled 'Normal' showing a healthy epithelial layer with a structured arrangement of cells and a clear basement membrane, serving as a control for comparison with leukoedema. Microscopic image labeled 'Leukoedema' displaying an epithelial layer with intracellular edema, characterized by a swollen, pale appearance and pyknotic nuclei, illustrating the histopathological features of leukoedema. # **Leukoedema** * **Differential diagnosis** * $\rightarrow$ White sponge nevus * $\rightarrow$ Frictional keratosis * $\rightarrow$ Oral lichen planus * $\rightarrow$ Other * ⭐**Leukoedema disappears on stretching!** #### Clinical Identification and Comparisons - **Differential Diagnosis Considerations:** - White sponge nevus - Frictional keratosis - Oral lichen planus - Other similar leukoplakic lesions - **Diagnostic Feature:** - A distinguishing characteristic is that Leukoedema disappears when the mucosa is stretched. **Leukoedema** **Differential diagnosis** $\rightarrow$ **The process of comparing the patient’s status with the known signs, symptoms and other features of the diseases that are possible causes of the patient’s condition or lesion** #### Definition of Differential Diagnosis Differential diagnosis is the process of comparing the patient’s status with the known signs, symptoms, and other features of the diseases that are possible causes of the patient’s condition or lesion. # Differential diagnosis ▪ Differential diagnosis   Discussion regarding the differential diagnosis process. A photo of an orange with a green leaf attached, presented as a visual example in a slide about differential diagnosis. A photo of a yellow banana, shown as a contrasting visual example in a slide about differential diagnosis. # Differential diagnosis * Differential diagnosis  Further considerations for differential diagnosis. A photo showing whole and sliced oranges on a white surface, illustrating the concept of differential diagnosis with a visual metaphor of different types of oranges. <table> <tr> <td>Murcott Mandarin</td> <td>Blood Orange</td> <td>Golden Nugget Mandarin</td> <td>Florida Grapefruit</td> </tr> <tr> <td>Seville Sour Orange</td> <td>Clementine</td> <td>Cara Cara</td> <td>Pink Grapefruit</td> </tr> <tr> <td>Mandarin</td> <td>Heirloom Navel</td> <td>Tangerine</td> <td>Juice Orange</td> </tr> </table>  #### Comparative Varieties - **Mandarins and Oranges:** - Murcott Mandarin - Seville Sour Orange - Mandarin - Blood Orange - Clementine - Heirloom Navel - Golden Nugget Mandarin - Cara Cara - Tangerine - **Grapefruit and Juice Varieties:** - Florida Grapefruit - Pink Grapefruit - Juice Orange A photo displaying various types of citrus fruits arranged on a wooden surface, each labeled with its name. The fruits include Murcott Mandarin, Blood Orange, Golden Nugget Mandarin, Florida Grapefruit, Seville Sour Orange, Clementine, Cara Cara, Pink Grapefruit, Mandarin, Heirloom Navel, Tangerine, and Juice Orange. The image is part of a slide titled 'Differential diagnosis' and appears to be used for comparative identification of different citrus varieties. $\text{Leukoedema}$ - **Treatment** $\rightarrow$ None required <\includegraphics[width=1.0\linewidth]{image.png}>  #### Treatment and Management - No treatment is required for this condition. A speaker icon with sound waves, indicating audio or sound output, located in the bottom right corner of a blue slide. **White sponge nevus** **White sponge nevus** * **Aetiology and pathogenesis** $\rightarrow$ Autosomal dominant condition #### Etiology and Pathogenesis - Autosomal dominant condition # **White sponge nevus** **Clinical features** $\rightarrow$ Appear early in life $\rightarrow$ White, thickened, spongy lesions $\rightarrow$ Usually bilateral and symmetric $\rightarrow$ Asymptomatic <img src="image1.png" alt="Image of white sponge nevus in the mouth"> Photos courtesy of Dr JE Bouquot  #### Clinical Features - Appear early in life - White, thickened, spongy lesions - Usually bilateral and symmetric - Asymptomatic A close-up photograph showing white, thickened, spongy lesions on the oral mucosa, consistent with white sponge nevus. The image is positioned next to a list of clinical features, including appearance early in life, bilateral symmetry, and asymptomatic nature. **<font color="yellow">White sponge nevus</font>** <img src="image1.png"> Photos courtesy of Dr JE Bouquet   Clinical presentation typically involves diffuse white plaques across the oral mucosa. Two close-up photos showing the oral cavity with white sponge nevus, characterized by thickened, white, corrugated patches on the buccal mucosa. The images illustrate the typical appearance of the condition, with one view showing the lesion adjacent to teeth and the other providing a broader view of the affected area. A close-up photo of the oral mucosa displaying white sponge nevus, with prominent white, spongy, and folded lesions on the buccal mucosa. The image highlights the characteristic texture and distribution of the condition, with the lesion extending across the inner cheek. <font color="yellow">**White sponge nevus**</font> <font color="yellow">**White sponge nevus**</font> - **Histopathology** - $\rightarrow$ Thickened epithelium - $\rightarrow$ Spongiosis, acanthosis, parakeratosis - $\rightarrow$ Perinuclear condensation of cytoplasm  #### Histopathology - Thickened epithelium - Spongiosis, acanthosis, and parakeratosis - Perinuclear condensation of cytoplasm Microscopic histopathology image showing thickened epithelium with spongiosis, acanthosis, and parakeratosis, characteristic of white sponge nevus, compared to a normal tissue sample in the inset. **White sponge nevus** **White sponge nevus** * **Differential diagnosis** * $\to$Leukoedema * $\to$Oral lichen planus * $\to$Frictional keratosis * $\to$Other  #### Differential Diagnosis - Leukoedema - Oral lichen planus - Frictional keratosis - Other hereditary or reactive keratoses A small speaker icon with sound waves, located in the bottom right corner of the slide, likely indicating an audio component or note. <font color="yellow">White sponge nevus</font> <font color="yellow">White sponge nevus</font> *<font color="orange">Treatment</font>* -> <font color="blue">None required</font> #### Treatment - None required # **Squamous papilloma** * **Aetiology and pathogenesis** * $\rightarrow$ **Benign lesions caused by the HPV (Types 6 and 11)**  #### Aetiology and Pathogenesis - Benign lesions caused by the Human Papillomavirus (HPV), specifically Types 6 and 11. A close-up photo of a squamous papilloma, showing a benign lesion on the mucosal surface. The lesion appears as a small, pinkish, cauliflower-like growth with a smooth texture, indicated by an arrow. This image illustrates the clinical appearance of a squamous papilloma caused by HPV Types 6 and 11. # **Squamous papilloma** - **Clinical features** - $\rightarrow$ **Distinctive exophytic lesions** - $\rightarrow$ **Cauliflower-like / finger like processes**  #### Clinical Features - Distinctive exophytic lesions - Cauliflower-like or finger-like processes A close-up photo showing a squamous papilloma in the throat, characterized by a distinctive exophytic lesion with cauliflower-like or finger-like processes. The lesion appears as a reddish, irregular growth on the mucosal surface, consistent with the clinical features described in the text. **<font color="yellow">Squamous papilloma</font>** <img src="image.png" alt="Intra-oral photograph showing a small, cauliflower-like, exophytic lesion on the buccal mucosa near the molar teeth, consistent with a squamous papilloma. The text 'Photos courtesy of Dr JE Bouquet' is visible at the bottom right area of the slide against the blue background."> Photos courtesy of Dr JE Bouquet  #### Clinical Presentation - Intra-oral presentation typically appears as a small, cauliflower-like, exophytic lesion. Common sites include the buccal mucosa near the molar teeth. Intra-oral photograph showing a small, cauliflower-like, exophytic lesion on the buccal mucosa near the molar teeth, consistent with a squamous papilloma. The image is a close-up view of the lesion, which appears pink and raised, with a textured surface. The surrounding tissue is normal oral mucosa, and the adjacent teeth are visible on the left side of the image. The photo is credited to Dr JE Bouquet. # **Squamous papilloma** ■ **Histopathology** → Stratified squamous epithelium supported by vascular connective tissue core → Koilocytes may be seen   #### Histopathology - Proliferation of stratified squamous epithelium supported by a vascular connective tissue core. - Koilocytes (cells showing HPV-related cytopathic changes) may be observed within the epithelium. Microscopic image showing squamous epithelium with koilocytes, indicated by arrows, in a tissue sample. The image highlights the characteristic cellular changes associated with squamous papilloma. Two histopathological images (a and b) of squamous papilloma, displaying stratified squamous epithelium supported by a vascular connective tissue core. The images show the typical morphology of the lesion, with the text indicating that koilocytes may be seen. # **Squamous papilloma** **Squamous papilloma** * **Diagnosis and treatment** * $\rightarrow$Clinical * $\rightarrow$Excision is curative #### Diagnosis and Treatment - **Diagnosis:** Primarily based on clinical presentation. - **Treatment:** Surgical excision is considered curative. # **Verruca vulgaris** * **Aetiology and pathogenesis** $\rightarrow$ Benign lesions caused by the HPV (Types 1 and 57 and also 6 and 11) #### Aetiology and Pathogenesis - Benign lesions caused by the Human Papillomavirus (HPV) - Associated with HPV Types 1 and 57, as well as Types 6 and 11 **Verruca vulgaris** * **Clinical presentation** * $\rightarrow$ Similar to squamous papilloma * $\rightarrow$ May be more round or only slightly raised Image from Contemporary Oral Medicine  #### Clinical Presentation - Similar appearance to squamous papilloma - Lesions may be more round in shape or only slightly raised from the surface A clinical photograph showing a verruca vulgaris lesion on oral mucosa, characterized by a slightly raised, pinkish-white growth. The image is sourced from Contemporary Oral Medicine and illustrates the clinical presentation described in the text, which notes the lesion may be more round or only slightly raised. **Verruca vulgaris** * **Histopathology** * $\rightarrow$ As for squamous papilloma * $\rightarrow$ Larger koilocytes Image from Contemporary Oral Medicine  #### Histopathology - Histological features are consistent with those of squamous papilloma - Characterized by the presence of larger koilocytes A histopathological image of verruca vulgaris, showing two sections of tissue stained with hematoxylin and eosin. The top section displays a papillomatous lesion with hyperkeratosis and acanthosis, while the bottom section reveals enlarged koilocytes and parakeratosis, characteristic of the condition. The image is sourced from Contemporary Oral Medicine. # **Verruca vulgaris** - **Diagnosis and treatment** $\rightarrow$ Clinical $\rightarrow$ Excision is curative  #### Diagnosis and Treatment - **Diagnosis:** Primarily based on clinical presentation - **Treatment:** Surgical excision is curative A speaker icon with sound waves, indicating audio or sound functionality, located in the bottom right corner of the slide. **Condyloma acumulatum** ■ **Aetiology and pathogenesis** $\rightarrow$ Benign lesions caused by the HPV (Types 2, 6 and 11) $\rightarrow$ Sexually transmitted disease #### Aetiology and Pathogenesis - Benign lesions caused by the Human Papillomavirus (HPV), specifically Types 2, 6, and 11. - Classified as a sexually transmitted disease. **Condyloma acumulatum** * **Clinical presentation** * $\rightarrow$ Numerous pink nodules that grow and coalesce <img src="image.png" alt="Two clinical photos showing condyloma acuminatum lesions in the mouth area. The left image shows a larger, pink, cauliflower-like nodule pointed to by a black arrow. The right image shows smaller, multiple pink nodules, with text below indicating 'Photos courtesy of Dr JE Bouquot'.">   #### Clinical Presentation - Characterized by numerous pink nodules. - These nodules tend to grow and coalesce over time, often forming larger, cauliflower-like masses. Two clinical photos showing condyloma acuminatum lesions in the mouth area. The left image shows a larger, pink, cauliflower-like nodule pointed to by a black arrow. The right image shows smaller, multiple pink nodules, with text below indicating 'Photos courtesy of Dr JE Bouquot'. A close-up clinical photo of a pink, cauliflower-like nodule in the oral cavity, highlighted by a black arrow, illustrating the clinical presentation of condyloma acuminatum. **Condyloma acumulatum** **Condyloma acumulatum** *Histopathology* $\rightarrow$ Papillary projections $\rightarrow$ May be keratinized or non-keratinized $\rightarrow$ Koilocytosis #### Histopathology - Presence of papillary projections. - Epithelium may be keratinized or non-keratinized. - Presence of koilocytosis (cells with perinuclear halos and nuclear atypia, indicative of HPV infection). **Condyloma acum in latum** * **Diagnosis and treatment** * $\rightarrow$ Clinical * $\rightarrow$ Excision is curative #### Diagnosis and Treatment - **Diagnosis:** Primarily clinical based on appearance and history. - **Treatment:** Surgical excision is considered curative. **Condyloma acumulatun** * **Significance in children?**  #### Clinical Considerations - What is the significance of these lesions when identified in children? A child's drawing depicting three stick figures, likely representing children, with simple features such as round heads, smiling faces, and basic clothing. The figure on the left has long hair and a dress, the middle figure has spiky hair and is holding a rectangular object, and the figure on the right has braided hair and a patterned outfit. The drawing is presented in the context of a slide titled 'Condyloma acuminatum' with a sub-question about its significance in children, suggesting the image is used to illustrate a discussion on pediatric health. Condyloma acumulatum * Significance in children? Government of Western Australia Department for Child Protection Mandatory reporting of child sexual abuse Child Protection Make the call  #### Significance in Children and Mandatory Reporting - Identification of these lesions in children raises significant concerns regarding child welfare. - In accordance with the Government of Western Australia Department for Child Protection guidelines: - Mandatory reporting of child sexual abuse is required. - Healthcare providers must follow child protection protocols and "make the call" to report suspected abuse. A banner image at the bottom of the slide featuring the logo and text for the Government of Western Australia, Department for Child Protection, with the message 'Mandatory reporting of child sexual abuse' and 'Child Protection Make the Call'. # **Physiologic (racial) pigmentation** * **Aetiology and pathogenesis** $\rightarrow$ Due to increased melanin production Photos courtesy of Dr JE Bouquet  #### Aetiology and Pathogenesis - Caused by increased melanin production. A close-up photograph of the oral cavity showing physiologic (racial) pigmentation on the gingiva, characterized by dark brown patches. The image illustrates increased melanin production as the cause of the pigmentation, consistent with the surrounding text discussing aetiology and pathogenesis. **Physiologic (racial) pigmentation** <img src="image_of_pigmented_tongue.png" alt="Image showing physiologic (racial) pigmentation on the surface of a tongue, with dark spots present. The tongue is being held by gloved fingers."> Photos courtesy of Dr JE Bouquet  Physiologic (racial) pigmentation can present as dark spots or patches on the surface of the tongue and other oral mucosal sites. A close-up photograph showing physiologic (racial) pigmentation on the surface of a tongue, with dark spots visible on the tongue's surface. The tongue is being held by gloved fingers, and the image is presented as an example of normal pigmentation patterns. Photos courtesy of Dr JE Bouquot. **Physiologic (racial) pigmentation** $\bullet$ **Clinical presentation** $\rightarrow$ Symmetric $\rightarrow$ No alteration of tissue architecture $\rightarrow$ Any age $\rightarrow$ May not correspond to degree of cutaneous pigmentation $\rightarrow$ No gender predilection $\rightarrow$ Any location #### Clinical Presentation - Symmetric distribution - No alteration of tissue architecture - Can occur at any age - Degree of oral pigmentation may not correspond to the degree of cutaneous pigmentation - No gender predilection - Can occur in any intraoral location **Physiologic (racial) pigmentation** * **Histopathology** * $\rightarrow$ Increased melanin production * $\rightarrow$ Melanin found in basal keratinocytes and subjacent connective tissue macrophages   #### Histopathology - Characterized by increased melanin production - Melanin is found within the basal keratinocytes and subjacent connective tissue macrophages A histopathological image labeled 'Normal' showing a cross-section of skin tissue with visible epidermis and dermis layers, stained to highlight cellular structures. A high-magnification histopathological image showing melanin deposition in basal keratinocytes and connective tissue macrophages, indicated by dark staining and an arrow pointing to the area of interest. **Physiologic (racial) pigmentation** * **Differential diagnosis** * $\rightarrow$ Smoking associated melanosis * $\rightarrow$ Addison's disease * $\rightarrow$ Peutz-Jeghers syndrome * $\rightarrow$ Melanoma * $\rightarrow$ Biopsy may be required if atypical clinical features  #### Differential Diagnosis - Smoking-associated melanosis - Addison's disease - Peutz-Jeghers syndrome - Melanoma #### Diagnostic Considerations - Biopsy may be required if atypical clinical features are present. The image displays a list of differential diagnoses for physiologic (racial) pigmentation, including smoking-associated melanosis, Addison's disease, Peutz-Jeghers syndrome, melanoma, and the need for biopsy if atypical clinical features are present. The text is presented in a bullet-point format with arrows indicating each item. **Physiologic (racial) pigmentation** * **Treatment** $\rightarrow$ None required #### Treatment - No treatment is required. # **Oral melanotic macules** * **Aetiology and pathogenesis** $\rightarrow$ Focal pigmented lesion that may represent: 1. *Intraoral freckle* 2. *Post-inflammatory pigmentation or* 3. *Systemic disease* #### Aetiology and Pathogenesis Oral melanotic macules are focal pigmented lesions that may represent several different conditions: - **Intraoral freckle**: A localized area of increased pigment. - **Post-inflammatory pigmentation**: Darkening of the tissue following an inflammatory process. - **Systemic disease**: Pigmentation as a manifestation of an underlying systemic condition. # **Oral melanotic macules** * **Clinical presentation** * $\rightarrow$ Benign * $\rightarrow$ Any oral surface may be affected * $\rightarrow$ Asymptomatic #### Clinical Presentation - **Nature**: Benign in character. - **Location**: May affect any oral mucosal surface. - **Symptoms**: Typically asymptomatic. **Oral melanotic macules**  Oral melanotic macules. A close-up photograph of a patient's oral cavity showing a dark, pigmented lesion on the gingiva, identified as an oral melanotic macule. The image is framed by a blue border with the title 'Oral melanotic macules' in yellow text at the top. **<font color="yellow">Oral melanotic macules</font>** Photos courtesy of Dr JE Bouquet  Oral melanotic macules. *Photos courtesy of Dr JE Bouquet* A close-up clinical photograph showing oral melanotic macules on the inner lining of the mouth, with a dark blue background and yellow text title 'Oral melanotic macules'. The image displays a reddish-pink mucosal surface with visible lesions, and the photo is credited to Dr JE Bouquet.     Close-up photo of oral mucosa showing dark melanotic macules on the inner cheek, with visible teeth and tongue in the background. Photo displaying melanotic macules on the floor of the mouth and tongue, with a focus on the pigmented lesions against the pink oral tissue. Image of the lower lip and gingiva showing multiple dark macules on the oral mucosa, with teeth and surrounding tissue visible. Photo of the lower jaw and tongue showing melanotic macules on the oral mucosa, with a clear view of the pigmented spots on the tongue and lip. **Oral melanotic macules** Generalized pigmentation due to Addison disease Rajesh Kumar, Sita Kumari, Pradeep Kumar Ranabijuli Dermatology Online Journal 14 (2): 13   #### Systemic Associations Generalized pigmentation due to Addison disease. *Reference: Rajesh Kumar, Sita Kumari, Pradeep Kumar Ranabijuli. Dermatology Online Journal 14 (2): 13* A photograph showing the feet of a person with generalized pigmentation, likely due to Addison disease, as indicated by the darkened skin on the toes and surrounding areas. A close-up photograph of a person's mouth displaying oral melanotic macules, characterized by dark pigmentation on the lips and gums, consistent with the condition discussed in the context of Addison disease. <font color="yellow">Oral melanotic macules</font> * <font color="orange">Histopathology</font> * $\rightarrow$ Melanin accumulation in basal keratinocytes * $\rightarrow$ Normal numbers of melanocytes  #### Histopathology - **Melanin accumulation**: Increased pigment is observed within the basal keratinocytes. - **Melanocyte count**: There are normal numbers of melanocytes present. A small speaker icon with sound waves, likely representing an audio feature or button, located at the bottom center of the slide. It is not related to the content about oral melanotic macules or histopathology. <font color='yellow'>Oral melanotic macules</font> * <font color='orange'>Differential diagnosis</font> * $\rightarrow$ Amalgam tattoos * $\rightarrow$ Nevi * $\rightarrow$ Malignant melanoma  #### Differential Diagnosis - Amalgam tattoos - Nevi - Malignant melanoma A speaker icon with sound waves, likely indicating an audio component or alert, positioned in the bottom right corner of the slide. # **Oral melanotic macules** * **Treatment** * $\rightarrow$ Biopsy may be required to establish definitive diagnosis * $\rightarrow$ No treatment required <img src="image_placeholder.png" alt="Speaker icon">  #### Treatment and Management - **Diagnosis**: A biopsy may be required to establish a definitive diagnosis and rule out other pigmented lesions. - **Intervention**: No specific treatment is required once a benign diagnosis is confirmed. A speaker icon with sound waves, indicating audio or sound functionality, located in the bottom right corner of the slide. # **Melanocytic nevus** **Melanocytic nevus** * **Aetiology and pathogenesis** $\rightarrow$ Collections of nevus cells $\rightarrow$ Found in epithelium or supporting connective tissue or both $\rightarrow$ Rare $\rightarrow$ May present at any age #### Aetiology and Pathogenesis - Consists of collections of nevus cells. - These cells are found in the epithelium, the supporting connective tissue, or both. - The condition is considered rare. - It may present at any age. **Melanocytic nevus** **Melanocytic nevus** * **Clinical presentation** * $\rightarrow$Small elevated papules or nodules * $\rightarrow$May be non-pigmented * $\rightarrow$Palate most common site <img src="image_of_oral_lesion.png" alt="Intraoral image showing a small dark lesion on the hard palate near the teeth."> Image from Contemporary Oral Medicine  #### Clinical Presentation - Appears as small elevated papules or nodules. - Lesions may be non-pigmented. - The palate is the most common intraoral site. A clinical photograph showing a small dark lesion on the hard palate, consistent with a melanocytic nevus. The image illustrates a pigmented papule, supporting the text's description of a small elevated nodule on the palate, the most common site for this condition. **Melanocytic nevus** **Melanocytic nevus** * **Histopathology** * $\rightarrow$ Several subtypes based on location of nevus cells * $\rightarrow$ Nests of pigmented nevus cells <img src="image.png" alt="Histopathology slide showing melanocytic nevus compared to normal tissue."> Normal Image from Contemporary Oral Medicine   #### Histopathology - Categorized into several subtypes based on the specific location of the nevus cells. - Characterized by nests of pigmented nevus cells. A histopathology slide showing a melanocytic nevus with nests of pigmented nevus cells, compared to normal tissue. The image displays a tissue sample with dark brown pigmented cells clustered in the dermis, illustrating the characteristic features of a nevus. A histopathology slide labeled 'Normal,' showing a cross-section of skin tissue with a regular arrangement of cells and no visible pigmented nevus cells, serving as a control for comparison with the melanocytic nevus. <font color='yellow'>Melanocytic nevus</font> <font color='yellow'>Melanocytic nevus</font> * **Differential diagnosis** * $\rightarrow$ Melanotic macule * $\rightarrow$ Amalgam tattoo * $\rightarrow$ Melanoma  #### Differential Diagnosis - Melanotic macule - Amalgam tattoo - Melanoma A speaker icon with sound waves, likely indicating an audio component or alert, positioned on the right side of the slide. # **Melanocytic nevus** **Melanocytic nevus** **Treatment** **Excision** <img src="image.png" alt="Image of a dark brown lesion on the oral mucosa, possibly a melanocytic nevus, with an arrow pointing to it. Text below says 'Image from Contemporary Oral Medicine'">  #### Treatment - Surgical excision is the indicated treatment. A close-up photograph of a dark brown lesion on the oral mucosa, identified as a melanocytic nevus, with an arrow pointing to the lesion. The image is sourced from Contemporary Oral Medicine and is displayed on a slide discussing treatment options, specifically excision. # **Nicotine stomatitis** - **Aetiology and pathogenesis** - $\rightarrow$ **Tobacco related form of hyperkeratosis** Photos courtesy of Dr JE Bouquot  #### Aetiology and Pathogenesis - Tobacco-related form of hyperkeratosis A clinical photograph showing the oral cavity with visible lesions on the palate, consistent with nicotine stomatitis. The image displays a tobacco-related form of hyperkeratosis, characterized by white, raised patches on the mucosal surface. This photo is credited to Dr JE Bouquot. **Nicotine stomatitis** * **Clinical presentation** * $\rightarrow$ Hyperkeratosis * $\rightarrow$ Inflamed salivary duct orifices Photos courtesy of Dr JE Bouquot  #### Clinical Presentation - Hyperkeratosis - Inflamed salivary duct orifices A clinical photograph showing the oral cavity with hyperkeratosis and inflamed salivary duct orifices, consistent with nicotine stomatitis. The image highlights the characteristic white, leathery appearance of the palate and the red, inflamed duct openings, with a black arrow pointing to a specific area of interest. Photos courtesy of Dr JE Bouquot. # **Nicotine stomatitis** * **Histopathology** $\rightarrow$ Epithelial hyperplasia and hyperkeratosis $\rightarrow$ Salivary glands show inflammatory salivary squamous metaplasia of excretory ducts  #### Histopathology - Epithelial hyperplasia and hyperkeratosis - Salivary glands show inflammatory salivary squamous metaplasia of excretory ducts A histopathological image showing epithelial hyperplasia and hyperkeratosis in the oral mucosa, with an arrow pointing to the affected area and another arrow indicating a duct. The image illustrates the characteristic features of nicotine stomatitis, including thickened epithelium and inflammatory changes in the salivary gland ducts. # **Nicotine stomatitis** **Nicotine stomatitis** * **Treatment** * $\rightarrow$ Malignant transformation rare * $\rightarrow$ Indicator of tobacco use <img src="speaker_icon.png" alt="Speaker Icon">  #### Treatment and Prognosis - Malignant transformation is rare - Condition serves as an indicator of tobacco use A speaker icon with sound waves emanating from it, located in the bottom right corner of the slide, likely indicating an audio feature or narration. # **Hairy tongue** * **Aetiology and pathogenesis** * $\rightarrow$ Filiform papillary overgrowth * $\rightarrow$ Numerous predisposing factors * $\checkmark$ Alteration in microbial flora #### Aetiology and Pathogenesis - Filiform papillary overgrowth - Numerous predisposing factors - Alteration in microbial flora # **Hairy tongue** * **Clinical presentation** * $\rightarrow$ Enlarged filiform papillae – dense hairlike * $\rightarrow$ Asymptomatic * $\rightarrow$ Cosmetic problem *Photos courtesy of Dr JE Bouquot*  #### Clinical Presentation - Enlarged filiform papillae appearing as dense and hairlike - Asymptomatic - Primarily a cosmetic problem A close-up clinical photograph showing a case of hairy tongue, characterized by enlarged filiform papillae that appear as dense, hairlike projections on the tongue surface. The image illustrates the condition described in the text as an asymptomatic cosmetic problem. **Hairy tongue** * **Histopathology** * $\rightarrow$Elongated filiform papillae * $\rightarrow$Surface contamination by clusters of micro-organisms and fungi * $\rightarrow$Underlying lamina propria is mildly inflamed <img src="speaker_icon.png" alt="Speaker icon"> #### Histopathology - Elongated filiform papillae - Surface contamination by clusters of micro-organisms and fungi - Underlying lamina propria is mildly inflamed **Hairy tongue** **Hairy tongue** * **Diagnosis** * $\rightarrow$ Clinical  #### Diagnosis - Clinical diagnosis A close-up clinical photograph of a human tongue exhibiting hairy tongue, characterized by elongated, dark-colored filiform papillae on the dorsal surface. The image is presented as part of a medical slide, with text indicating 'Hairy tongue' and 'Diagnosis → Clinical' on the left side. # **Hairy tongue** **Treatment** $\rightarrow$ Identify cause $\rightarrow$ Gentle scraping / sodium bicarbonate #### Treatment and Management - Identify the underlying cause - Gentle scraping of the tongue - Use of sodium bicarbonate # **Summary** * **Common problems occur commonly!** * **Important to recognize benign pathosis for what they are** * **Appropriate referral pathways** #### Key Principles of Benign Epithelial Pathosis - **Common problems occur commonly!** - It is important to recognize benign pathosis for what they are to avoid unnecessary concern or intervention. - Ensure appropriate referral pathways are followed when clinical findings require specialist evaluation. [^1]: Original PDF page 1: [[L9 Benign Epithelial Pathosis.pdf#page=1|L9 Benign Epithelial Pathosis, p.1]] [^2]: Original PDF page 2: [[L9 Benign Epithelial Pathosis.pdf#page=2|L9 Benign Epithelial Pathosis, p.2]] [^3]: Original PDF page 3: [[L9 Benign Epithelial Pathosis.pdf#page=3|L9 Benign Epithelial Pathosis, p.3]] [^4]: Original PDF page 4: [[L9 Benign Epithelial Pathosis.pdf#page=4|L9 Benign Epithelial Pathosis, p.4]] [^5]: Original PDF page 5: [[L9 Benign Epithelial Pathosis.pdf#page=5|L9 Benign Epithelial Pathosis, p.5]] [^6]: Original PDF page 6: [[L9 Benign Epithelial Pathosis.pdf#page=6|L9 Benign Epithelial Pathosis, p.6]] [^7]: Original PDF page 7: [[L9 Benign Epithelial Pathosis.pdf#page=7|L9 Benign Epithelial Pathosis, p.7]] [^8]: Original PDF page 8: [[L9 Benign Epithelial Pathosis.pdf#page=8|L9 Benign Epithelial Pathosis, p.8]] [^9]: Original PDF page 9: [[L9 Benign Epithelial Pathosis.pdf#page=9|L9 Benign Epithelial Pathosis, p.9]] [^10]: Original PDF page 10: [[L9 Benign Epithelial Pathosis.pdf#page=10|L9 Benign Epithelial Pathosis, p.10]] [^11]: Original PDF page 11: [[L9 Benign Epithelial Pathosis.pdf#page=11|L9 Benign Epithelial Pathosis, p.11]] [^12]: Original PDF page 12: [[L9 Benign Epithelial Pathosis.pdf#page=12|L9 Benign Epithelial Pathosis, p.12]] [^13]: Original PDF page 13: [[L9 Benign Epithelial Pathosis.pdf#page=13|L9 Benign Epithelial Pathosis, p.13]] [^14]: Original PDF page 14: [[L9 Benign Epithelial Pathosis.pdf#page=14|L9 Benign Epithelial Pathosis, p.14]] [^15]: Original PDF page 15: [[L9 Benign Epithelial Pathosis.pdf#page=15|L9 Benign Epithelial Pathosis, p.15]] [^16]: Original PDF page 16: [[L9 Benign Epithelial Pathosis.pdf#page=16|L9 Benign Epithelial Pathosis, p.16]] [^17]: Original PDF page 17: [[L9 Benign Epithelial Pathosis.pdf#page=17|L9 Benign Epithelial Pathosis, p.17]] [^18]: Original PDF page 18: [[L9 Benign Epithelial Pathosis.pdf#page=18|L9 Benign Epithelial Pathosis, p.18]] [^19]: Original PDF page 19: [[L9 Benign Epithelial Pathosis.pdf#page=19|L9 Benign Epithelial Pathosis, p.19]] [^20]: Original PDF page 20: [[L9 Benign Epithelial Pathosis.pdf#page=20|L9 Benign Epithelial Pathosis, p.20]] [^21]: Original PDF page 21: [[L9 Benign Epithelial Pathosis.pdf#page=21|L9 Benign Epithelial Pathosis, p.21]] [^22]: Original PDF page 22: [[L9 Benign Epithelial Pathosis.pdf#page=22|L9 Benign Epithelial Pathosis, p.22]] [^23]: Original PDF page 23: [[L9 Benign Epithelial Pathosis.pdf#page=23|L9 Benign Epithelial Pathosis, p.23]] [^24]: Original PDF page 24: [[L9 Benign Epithelial Pathosis.pdf#page=24|L9 Benign Epithelial Pathosis, p.24]] [^25]: Original PDF page 25: [[L9 Benign Epithelial Pathosis.pdf#page=25|L9 Benign Epithelial Pathosis, p.25]] [^26]: Original PDF page 26: [[L9 Benign Epithelial Pathosis.pdf#page=26|L9 Benign Epithelial Pathosis, p.26]] [^27]: Original PDF page 27: [[L9 Benign Epithelial Pathosis.pdf#page=27|L9 Benign Epithelial Pathosis, p.27]] [^28]: Original PDF page 28: [[L9 Benign Epithelial Pathosis.pdf#page=28|L9 Benign Epithelial Pathosis, p.28]] [^29]: Original PDF page 29: [[L9 Benign Epithelial Pathosis.pdf#page=29|L9 Benign Epithelial Pathosis, p.29]] [^30]: Original PDF page 30: [[L9 Benign Epithelial Pathosis.pdf#page=30|L9 Benign Epithelial Pathosis, p.30]] [^31]: Original PDF page 31: [[L9 Benign Epithelial Pathosis.pdf#page=31|L9 Benign Epithelial Pathosis, p.31]] [^32]: Original PDF page 32: [[L9 Benign Epithelial Pathosis.pdf#page=32|L9 Benign Epithelial Pathosis, p.32]] [^33]: Original PDF page 33: [[L9 Benign Epithelial Pathosis.pdf#page=33|L9 Benign Epithelial Pathosis, p.33]] [^34]: Original PDF page 34: [[L9 Benign Epithelial Pathosis.pdf#page=34|L9 Benign Epithelial Pathosis, p.34]] [^35]: Original PDF page 35: [[L9 Benign Epithelial Pathosis.pdf#page=35|L9 Benign Epithelial Pathosis, p.35]] [^36]: Original PDF page 36: [[L9 Benign Epithelial Pathosis.pdf#page=36|L9 Benign Epithelial Pathosis, p.36]] [^37]: Original PDF page 37: [[L9 Benign Epithelial Pathosis.pdf#page=37|L9 Benign Epithelial Pathosis, p.37]] [^38]: Original PDF page 38: [[L9 Benign Epithelial Pathosis.pdf#page=38|L9 Benign Epithelial Pathosis, p.38]] [^39]: Original PDF page 39: [[L9 Benign Epithelial Pathosis.pdf#page=39|L9 Benign Epithelial Pathosis, p.39]] [^40]: Original PDF page 40: [[L9 Benign Epithelial Pathosis.pdf#page=40|L9 Benign Epithelial Pathosis, p.40]] [^41]: Original PDF page 41: [[L9 Benign Epithelial Pathosis.pdf#page=41|L9 Benign Epithelial Pathosis, p.41]] [^42]: Original PDF page 42: [[L9 Benign Epithelial Pathosis.pdf#page=42|L9 Benign Epithelial Pathosis, p.42]] [^43]: Original PDF page 43: [[L9 Benign Epithelial Pathosis.pdf#page=43|L9 Benign Epithelial Pathosis, p.43]] [^44]: Original PDF page 44: [[L9 Benign Epithelial Pathosis.pdf#page=44|L9 Benign Epithelial Pathosis, p.44]] [^45]: Original PDF page 45: [[L9 Benign Epithelial Pathosis.pdf#page=45|L9 Benign Epithelial Pathosis, p.45]] [^46]: Original PDF page 46: [[L9 Benign Epithelial Pathosis.pdf#page=46|L9 Benign Epithelial Pathosis, p.46]] [^47]: Original PDF page 47: [[L9 Benign Epithelial Pathosis.pdf#page=47|L9 Benign Epithelial Pathosis, p.47]] [^48]: Original PDF page 48: [[L9 Benign Epithelial Pathosis.pdf#page=48|L9 Benign Epithelial Pathosis, p.48]] [^49]: Original PDF page 49: [[L9 Benign Epithelial Pathosis.pdf#page=49|L9 Benign Epithelial Pathosis, p.49]] [^50]: Original PDF page 50: [[L9 Benign Epithelial Pathosis.pdf#page=50|L9 Benign Epithelial Pathosis, p.50]] [^51]: Original PDF page 51: [[L9 Benign Epithelial Pathosis.pdf#page=51|L9 Benign Epithelial Pathosis, p.51]] [^52]: Original PDF page 52: [[L9 Benign Epithelial Pathosis.pdf#page=52|L9 Benign Epithelial Pathosis, p.52]] [^53]: Original PDF page 53: [[L9 Benign Epithelial Pathosis.pdf#page=53|L9 Benign Epithelial Pathosis, p.53]] [^54]: Original PDF page 54: [[L9 Benign Epithelial Pathosis.pdf#page=54|L9 Benign Epithelial Pathosis, p.54]] [^55]: Original PDF page 55: [[L9 Benign Epithelial Pathosis.pdf#page=55|L9 Benign Epithelial Pathosis, p.55]] [^56]: Original PDF page 56: [[L9 Benign Epithelial Pathosis.pdf#page=56|L9 Benign Epithelial Pathosis, p.56]] [^57]: Original PDF page 57: [[L9 Benign Epithelial Pathosis.pdf#page=57|L9 Benign Epithelial Pathosis, p.57]] [^58]: Original PDF page 58: [[L9 Benign Epithelial Pathosis.pdf#page=58|L9 Benign Epithelial Pathosis, p.58]] [^59]: Original PDF page 59: [[L9 Benign Epithelial Pathosis.pdf#page=59|L9 Benign Epithelial Pathosis, p.59]] [^60]: Original PDF page 60: [[L9 Benign Epithelial Pathosis.pdf#page=60|L9 Benign Epithelial Pathosis, p.60]] [^61]: Original PDF page 61: [[L9 Benign Epithelial Pathosis.pdf#page=61|L9 Benign Epithelial Pathosis, p.61]] [^62]: Original PDF page 62: [[L9 Benign Epithelial Pathosis.pdf#page=62|L9 Benign Epithelial Pathosis, p.62]] [^63]: Original PDF page 63: [[L9 Benign Epithelial Pathosis.pdf#page=63|L9 Benign Epithelial Pathosis, p.63]] [^64]: Original PDF page 64: [[L9 Benign Epithelial Pathosis.pdf#page=64|L9 Benign Epithelial Pathosis, p.64]] [^65]: Original PDF page 65: [[L9 Benign Epithelial Pathosis.pdf#page=65|L9 Benign Epithelial Pathosis, p.65]]