Basic Disease Processes Etiology (Cause ex.mycobact. Tuberc.) Pathogenesis` (Mechanisms:inflammation) Clinical Features (Signs and Symptoms) Fever, cough, sputum, abnormal xray

Signs of Disesase Measurable / Observable Examples: Fever, Bleeding, “Lesions” Phsical evidence of disease processes.

Clinical Area of Abnormality Associated with Disease / Disease Process “Lesions” Clinical Area of Abnormality Associated with Disease / Disease Process Lesions: generic term for an abnormality. Blueish grey to black macule is what this one.

Symptoms of Disease Subjective Example: Pain, Paresthesia Signs can be observed and or measured. Symptoms cannot.

Basic Disease Processes Pathogenetic Mechanisms - M I N D - M etabolic - Hormonal; Nutritional Example: Diabetes Mellitus I nflammatory - Infection, Immunologic Examples: Tuberculosis, Pemphigus N eoplastic - Any Neoplasm, Benign or Malignant Examples: Papilloma, Squamous Cell Carcinoma D evelopmental - Genetic or Acquired Malformation Example: Mandibular Torus No need to memorize this right now. Couldn’t hurt, though.

Evaluation and Characterization of Soft Tissue “Lesions” 1. Type of “Lesion” 2. Color of “Lesion” (Be Specific) 3. Surface Characteristics of “Lesion” 4. Palpable Features of “Lesions” 5. Attachment of “Lesions” ALSO NOTE: 1. Size (in mm. or cm. or compared to known object - “dime-sized” or “grape sized”) 2. Specific Location of Lesion (Using Oral Togography) 3. Number of lesions (if more than one) AND: 1. History : Duration and Changes and Rate of Changes 2. Symptoms: Asymptomatic (ASX), Pain, Tenderness

Types of “Lesions” plaque nodule cyst FLAT LESIONS Macule Plaque Ulcer Swellings (Solid Tissue) Papule Nodule Tumor Swellings (Fluid-Filled) Vesicle Bulla Pustule/Abscess Cyst Combinations of Types plaque nodule cyst

FLAT LESIONS Macule Plaque Ulcer Amalgam tattoo is a macule. You can see it but not feel it. Plaque is barely raised.

TYPE - Macule A flat lesion - color change ONLY - Not paplable at all !! When examining Indicate Specific Color This macule is an Amalgam Tattoo Description: A Single 8x10 mm. Bluish-Grey pigmented macule of the left mandibular buccal edentulous alveolar ridge mucosa (missing #19 area) People with addisons disease get a lot of macules “freckles” in the mouth. 8 mm. 10 mm.

TYPE - Plaque A flat and slightly raised lesion: palpable Some may be Wiped Off Usually white Often a thickening of the keratin surface This plaque is a “pre-cancerous” epithelial dysplasia Description: A single 8x12 mm. irregular shaped rough surfaced leukoplakia (non-wipable white plaque) of the right lateral tongue.

TYPE - Ulcer Localized area of complete loss of surface epithelium Crusted/Scabbed on skin - Pseudomembrane intraorally Often Painful May be result of trauma, infection, cancer or other disease These two ulcers are “Canker Sores / Aphthous Ulcers” Pseudomembrane overlying Exposed Connective Tissue

TYPE - Ulcer / Other Examples Both of these lesions are Squamous Cell Carcinomas

SWELLINGS (Solid Tissue) Categorized by Size Papule ~1-2 mm Nodule < 1 cm Tumor > 1 cm

Papule (Solid Tissue Swelling) Small (1-2 mm) Swelling of Solid Tissue These Papules are Fordyce Granules (Ectopic Sebaceous Glands) Solid tissue

Nodule (Solid Tissue Swelling) “Larger” ( up to 1 cm.) Swelling of Solid Tissue May be Hyperplasia, benign of malignant neoplasm This Nodule is Hyperplasia - “Pyogenic Granuloma”

Tumor (Solid Tissue Swelling) Larger still (> 1 cm) Swelling of Solid Tissue May be Hyperplasia or Neoplasm of Epithelium or of Connective Tissue This Tumor is a Benign Neoplasm of Accessory Salivary Gland Origin - a Pleomorphic Adenoma

TYPE - Vesicle (Fluid Filled Swelling) “Small” < 2 mm. Blister (Fluid Filled and Intraepithelial) Most commonly the result of viral (Herpes) infection or allergy These Vesicles are due to Recurrent Herpes simples infection Intraepithelial Fluid

TYPE - Bulla (Fluid Filled Swelling) “Large” Blister - Fluid Filled and Intraepithelial Usually Immunopathic Disease - Pemphigus, etc. This Bulla is the result of Pemphigus Vulgaris Collapsed Bulla (Ruptured and Fluid has Escaped) Intraepithelial Fluid Residual Ulcers

TYPE - Cyst (Fluid Filled Swelling) Pathologic Cavity / Space Lined by Epithelium Usually Filled with Fluid Swelling in soft tissue -Radiolucency in Jaws This Cyst is a Mucous Retention Cyst Fluid Cyst Epithelial Lining Fluid Epithelial Lining

Surface Characteristics of “Lesions” Smooth Papillary / Verrucous Ulcerated Smooth Papillary Verrucous Ulcerated

Smooooooth

Papillary

Ulcerated Loss of Area of Surface Epithelium Some would consider this a nodule with a cratered ulceration in the middle. Know colors too. Ulcerated

Palpable Characteristics of “Lesions” Compressible Fluctuant Pressure Displaces Fluid Soft (Solid Tissue) Firm (Solid Tissue) Hard Indurated (Usually applies to Malignancy) Bony (Hard as Bone) Fluctuant Fluid Usually we just say indurated when we suspect malignancy. Indurated

Attachment of “Lesions” - Soft Tissue Masses - Pedunculated Attached by a Narrow Stalk Sessile Attached by a Broad Base Palpation Movable Fixed Pedunculated Sessile Moveable is good. Fixed is a bad sign. Got to feel it to know it. Imagine a marble. If it rolls around, that is a good thing. Movable Fixed

Pedunculated Attached by a Narrow Stalk

Sessile Attached to Normal Tissue by a Broad Base

ORAL “CANCER” - Any Malignant Neoplasm - 96% “Carcinoma” (Epithelial) 91% “Squamous Cell Carcinoma Carcinoma: epithelial Sarcoma: not epithelial. So 4% of malig. Neopl. In mouth are sarcomas.

ORAL CANCER Squamous Cell Carcinoma Invasive Neoplasm of Malignant Squamous Epithelium Malignant Squamous Cells Invading Muscle

Clinical Features - Oral SCCA - Leukoplakia - White Plaque Erythroleukoplakia - Red and White Plaque Erythroplakia - Red Plaque The more settle the change, the more likely it is early. Cuando el tumor esta mas grande, hay menos posibilidad de prognosis bueno. Ulcer with Crust / Scab Tumor with Surface Ulcer

ORAL CANCER “TNM” Classification and Staging Primary Cancer - “T” Local Metastasis - “N” (Regional Lymph Nodes) (Such as Lung)

ORAL CANCER Pre-Malignant Lesions “Pre-malignant” = Any Lesion with Increased Potential to Become Malignant Leukoplakia= white plaque erythroplakie=red plaque Carcinoma in situ is not malignant.

“Premalignant” Lesions” Leukoplakia 80 % Hyperkeratosis Transformation ~ 6 % 17-19 % Dysplasia Increased Transformation Risk (1-3 % “Early” SCCA) Erythroplakia/ Erythroleukoplakia 80 + % Dysplasia (or SCCA) Much Greater Risk of Cancer or Transformation Leukoplakia ErythroLeukoplakia So… translation… 80% of leukop. Are hyperkeratosis – basically a callous – 6% of those can transform into something cancerous. So…red is a whole lot worse than white, generally speaking. Erythroplakia