1. Description of Lesions 1800 Introduction to Clinical Procedures Tiffany Baggs, RDH, BASDH

2. Lesions of all kinds  Elevated Lesions  Depressed Lesions  Flat Soft Tissue Lesions  All lesions: Single or Multiple  Wilkins page 151-156

3. Elevated Lesions  Blisterform: fluid filled, soft and translucent  Vesicle: small 1cm or less, serum or mucin  Pustule: any size, pus, yellowish  Bulla: large 1 cm or more, serum or mucin, blood

4. Elevated Lesions  Nonblisterform: solid lesion, no fluid, firm  Plaque: “pasted on appearance”  Papule: small, solid, pointed, rounded or flat topped,  Nodule: larger than a papule greater than 5 mm less than 1 cm  Tumor: 2 cm or greater, general swelling or enlargement

5. Papules, Nodules, Tumors Take note of the base of lesion  Pedunculated: attached to narrow stalk  Sessile: base as wide as lesion

6. Depressed Lesions  Below the level of the skin or mucosa  Ulcer: loss of continuity of the epithelium, gray to yellow, surrounded by red  Erosion: shallow, depressed lesion that does not extend through the epithelium  Regular / Irregular Outline  Smooth / Raised Margin  Superficial / Deep

7. Flat Lesions or macule  Single macule or Mulitiple macules  Regular / Irregular

8. Other Descriptions  Crust  Erythema  Exophytic  Indurated  Papillary  Petechiae  Pseudomembrane  Polyp  Punctuate  Torus  Verrucous

9. Oral Cancer  Any patient  Red flag:  Tobacco use  Alcohol use  Sun exposure

10.  Discovery- the earlier the better  Head, Neck, Oral Examination  Every appointment/Document  Common site  Floor of the mouth  Tongue lateral border  Lower lip  Soft Palate  (gingiva, buccal mucosa, oropharynx)  Self-examination for Patients

11. Many forms  White areas  Red Areas  Ulcers  Masses  Pigmentation

12.  Area to be watched, documented  If area does not change/heal, what do we do?

13.  Return in two weeks  Biopsy: removal and examinations of a sections of tissue  Cytologic smear: surface cells are removed  Not biopsied- patient refuses biopsy  Referral out for biopsy: dermatologist, oral surgeon  Exfoliative cytology

14. Oral Cancer Detections Systems  Velscope  ViziLite

15. Velscope http://velscope.com/about_velscope/ Cordless, portable and rechargeable: “ring of light” illumination  healthy cells in the mouth fluoresce= emitting a bright green glow  Unhealthy cells, lack of fluorescence= appearing dark when viewed against the healthy tissue.

16. ViziLite http://www.zila.com/40/VIZILITE%26REG%3B%20PLUS/  slightly desicates the cells to make the nuclei more prominent, more visible  low intensity light from the handheld light source is reflected off of these abnormal cells down to the basement membrane where the nuclei have been rendered more prominent, and appear to "glow" – making abnormal cells easier to see.  Mouthrinse, dyes  Patient rinses with a solution for 1 minute, expectorates, lights are dimmed or special glasses used, handheld light stick is used  Suspicious areas turn a blue color

17. Documentation (A,B,C,D,&T)  Anatomic location  where is it?  Border  demarcated? Regular or irregular?  Color change configuration  Color, patter?  Diameter/dimension  Irregular, oblong: length x width  Circular: diameter  Type  Flat  Elevated  Fluid filled  Loss of skin/mucosa

18. Documentation  Have a baseline  Note what kind of lesion  Follow up appointments- note any changes  For legal purposes be as detailed as possible.

19. Teach Patient  Self examination  Diet, nutritional effects on health  Oral health tends to reflect general health

20. Warning Signs of Oral Cancer  Swelling, lump, or growth – with or without pain  White scaly patches  Red velvety areas  Sores that do not heal in 2 weeks  Numbness, tingling  Excessive dryness or wetness  Hoarseness, sore throat, persistent coughing or feeling of “lump in the throat”  Difficulty swallowing  Difficulty in opening the mouth

21. THE END…………..