8 Oral Cancer

7/24/2019 8 Oral Cancer

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Oral cancer

Oral cancer is a subtype of

head and neck cancer, is anycancerous tissue growthlocated in the oral cavity.


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Signs and symptoms

Skin lesion, lump, or ulcer that do not resolve in 14 days located: On the tongue, lip, or other mouth areas Usually small ost often pale colored, be dark or discolored !arly sign may be a white patch "leukoplakia# or a red patch

"erythroplakia# on the soft tissues of the mouth Usually painless initially ay develop a burning sensation or pain when the tumor is

advanced

$dditional symptoms that may be associated with this disease:

%ongue problems Swallowing di&culty outh sores 'ain and paraesthesia are late symptoms.


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(eukoplakia

(eukoplakia is a clinical term used todescribe patches of keratosis. )t is visible asadherent white patches on the mucousmembranes of the oral cavity, including the

tongue, but also other areas of the gastro*intestinal tract, urinary tract and thegenitals. %he clinical appearance is highlyvariable. (eukoplakia is not a speci+cdisease entity, but is diagnosis of eclusion.

)t must be distinguished from diseases thatmay cause similar white lesions, such ascandidiasis or lichen planus. %he lesions ofleukoplakia cannot be scraped o- easily


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%he white lesion is an eampleof leukoplakia.


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)ncidence and prevalence

(eukoplakic lesions are found inapproimately / of the world0spopulation. (ike erythroplakia,leukoplakia is usually found in adultsbetween 4 and 2 years of age,with a 3:1 male predominance.


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auses

(eukoplakia is primarily caused by the useof tobacco. Other possible etiological agentsimplicated are 5'6, andida albicans andpossibly alcohol. Simultaneously serumlevels of patients with leukoplakia werefound to be low in 6it $,7*13, 8 folic acid,ina study conducted in )ndia. ost result fromchronic irritation of mucous membranes by

carcinogens.9citation needed 7loodroot,otherwise known as sanguinaria, is alsobelieved to be associated with leukoplakia


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%reatment

%he treatment of leukoplakia mainly involvesavoidance of predisposing factors ; tobaccocessation, smoking,


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S


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Oral s


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%reatment

@hile most cases re


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S


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Auick Beview

%he papilloma is a benign mucosal massproduced by a strain of the papillomavirus, thevirus which produces skin warts. )t seldom islarge but may become a couple of centimeters

across. )t is painless, usually white butsometimes pink, and has long or short surfaceproCections with rounded or pointed ends. )toften is on a stalk and only one lesion is usuallyfound. Once present, it remains inde+nitely. )nthe throat a similar lesion may occasionally goon to cancer, but in the mouth this has neverbeen reported. %he papilloma is notcontagious, like a wart, and can be removed byconservative surgery or laser destruction.


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Deratoacanthoma

Deratoacanthoma "D$# is a commonlow*grade "unlikely to metastasiEe orinvade# skin tumour that is believed

to originate from the neck of the hairfollicle.


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Deratoacanthoma.


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!tiology

%he tumors usually occur in olderindividuals "mean age ?4 years old#.(ike s


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Hiagnosis

Hiagnosis is best done with clinicaleam and history. )t presents as aIeshy, elevated and nodular lesion

with an irregular crater shape and acharacteristic central hyperkeratoticcore. Usually the patient will notice a

rapidly growing dome*shaped tumoron sun*eposed skin


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Skin keratoacanthomawhole slide.


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%reatment

On the trunk, arms, and legs, electrodesiccationand curettage often su&ce. !cision of the entirelesion is often re


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7owen0s disease

7owen0s disease "7H# "also known asKs># is a neoplastic skin disease,

it can be considered as an early stage orintraepidermal form of s


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7owen0s disease as seen undera microscope


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auses

auses of 7H include solar damage,arsenic, immunosuppression"including $)HS#, viral infection

"human papillomavirus or 5'6# andchronic skin inCury and dermatoses.


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Signs and symptoms

7owen0s disease typically presents as agradually enlarging, well demarcatederythematous pla


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5istology

7owen0s disease is essentially e


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%reatment

'hotodynamic therapy "'H%#, ryotherapy"freeEing# or local chemotherapy "with >*Iuorouracil# are favored by some cliniciansover ecision. 7ecause the cells of 7owen0s

disease have not invaded the dermis, it hasa much better prognosis than invasives


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$dditional images


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$ctinic keratosis

$ctinic keratosis "also called KsolarkeratosisK and Ksenile keratosisK# is apremalignant condition of thick, scaly, orcrusty patches of skin.:21F )t is more

common in fair*skinned people. )t isassociated with those who are fre


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$ctinic keratosis on the lip


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lassi+cation

5yperkeratotic actinic keratosis

'igmented actinic keratosis

(ichenoid actinic keratosis $trophic actinic keratosis


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'revention

Mot staying in the sun for long periods oftime without protection "e.g., sunscreen,clothing, hats#.

=re


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Hiagnosis

Hoctors can usually identify $D by doing athorough eamination. $ biopsy may benecessary when the keratosis is largeandNor thick, to make sure that the bumpis a keratosis and not a skin cancer.Seborrheic keratoses are other bumpsthat appear in groups like the actinickeratosis but are not caused by suneposure, and are not related to skincancers. Seborrheic keratoses may bemistaken for an actinic keratosis


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5istopathology

$ctinic keratosis usually shows focalparakeratosis with associated loss of thegranular layer, and thickening of theepidermis. %he normal ordered maturationof the keratinocytes is disordered tovarying degrees, there may be widening ofthe intracellular spaces, and they may alsohave some cytologic atypia, such as

abnormally large nuclei. %he underlyingdermis often shows severe actinic elastosisand a mild chronic inIammatory in+ltrate


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%reatment

Hiclofenac sodium / gel, a nonsteroidal anti*inIammatorydrug9?. Becommended duration of therapy is ? to F days.

ryosurgery, e.g. with li*Iuorouracil "a chemotherapy agent#: a cream that contains

this medication causes $Ds to become red and inIamedbefore they fall o- 'hotodynamic therapy:9L this new therapy involves inCecting

a chemical into the bloodstream, which makes $Ds moresensitive to any form of light9F.

(aser, notably O3 and !r:$P lasers. $ (aser resurfacingtechni


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utaneous horn

utaneous horns, also known by the (atinname cornu cutaneum, are unusualkeratinous skin tumors with the

appearance of horns, or sometimes ofwood or coral. =ormally, this is a clinicaldiagnosis for a Kconical proCection abovethe surface of the skin.K %hey are usuallysmall and localiEed, but can in very rarecases be much larger. $lthough oftenbenign, they can also be malignant orpremalignant.


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!tiology

%he cause of cutaneous horns is stillunknown, but it is believed that eposureto radiation can trigger the condition. %hisis evidenced by a higher rate of casesoccurring on the face and hands, areasthat are often eposed to sunlight. Othercases have reported cutaneous hornsarising from burn scars. $s with manyother wart*like skin conditions, a link tothe 5'6 virus family, especially the 5'6*3subtype has been suggested.


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'rominent cases

Qhang Buifang, aged 11 "living in (inlou 6illage,5enan province, hina#, has grown a cutaneoushorn on her forehead, resembling what those whohave eamined her and her family call KHevil0s5orns.K Motably, this growth has epanded to reach

a total of ? centimeters in length. $nother isforming on the opposite side of her forehead.9>

adame Himanche, called @idow Sunday, a =renchwoman living in 'aris in the early 1Fth century,grew, in si years from the age of 2?, a 34.F cm

"F.LK# horn from her forehead before it wassuccessfully removed by =rench surgeon 7r. GosephSouberbeille "12>4R1L4?#. $ wa model of her headis on display at the tter useum, %he ollege of'hysicians of 'hiladelphia, US


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ortalityNorbidity

%he lesion at the base of the keratinmound is benign in the maCority of cases.alignancy is present in up to 3/ of

cases, with s


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%reatments

$s the horn is composed of keratin, thesame material found in +ngernails, thehorn can usually be removed with a

sterile raEor.

5owever, the underlying condition will

still need to be treated. %reatmentsvary, but they can include surgery,radiation therapy, and chemotherapy.


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8 Oral Cancer