Oral cancer
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Oral cancer. Oral cancer is a subtype of head and neck cancer, is any cancerous tissue growth located in the oral cavity. 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

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Oral cancer

Oral cancer

Oral cancer is a subtype of head and neck cancer, is any cancerous tissue growth located in the oral cavity.


Signs and symptoms

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

  • Most often pale colored, be dark or discolored

  • Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth

  • Usually painless initially

  • May develop a burning sensation or pain when the tumor is advanced

  • Additional symptoms that may be associated with this disease:

  • Tongue problems

  • Swallowing difficulty

  • Mouth sores

  • Pain and paraesthesia are late symptoms.


Leukoplakia

Leukoplakia

  • Leukoplakia is a clinical term used to describe patches of keratosis. It is visible as adherent white patches on the mucous membranes of the oral cavity, including the tongue, but also other areas of the gastro-intestinal tract, urinary tract and the genitals. The clinical appearance is highly variable. Leukoplakia is not a specific disease entity, but is diagnosis of exclusion. It must be distinguished from diseases that may cause similar white lesions, such as candidiasis or lichen planus. The lesions of leukoplakia cannot be scraped off easily


The white lesion is an example of leukoplakia

The white lesion is an example of leukoplakia.


Incidence and prevalence

Incidence and prevalence

  • Leukoplakic lesions are found in approximately 3% of the world's population. Like erythroplakia, leukoplakia is usually found in adults between 40 and 70 years of age, with a 2:1 male predominance.


Causes

Causes

  • Leukoplakia is primarily caused by the use of tobacco. Other possible etiological agents implicated are HPV, Candida albicans and possibly alcohol. Simultaneously serum levels of patients with leukoplakia were found to be low in Vit A,B-12,C & folic acid,in a study conducted in India. Most result from chronic irritation of mucous membranes by carcinogens.[citation needed] Bloodroot, otherwise known as sanguinaria, is also believed to be associated with leukoplakia


Treatment

Treatment

  • The treatment of leukoplakia mainly involves avoidance of predisposing factors — tobacco cessation, smoking, quitting betel chewing, abstinence from alcohol — and avoidance of chronic irritants, e.g., the sharp edges of teeth. A biopsy should be done, and the lesion surgically excised if pre-cancerous changes or cancer is detected.

  • Taking beta-carotene orally seems to induce remission in patients with oral leukoplakia. Further research is needed to confirm these results


Squamous cell papilloma

Squamous cell papilloma

  • A Squamous cell papilloma is a generally benign papilloma that arises from the stratified squamous epithelium of the skin, lip, oral cavity, tongue, pharynx, larynx, esophagus, cervix, vagina or anal canal.Squamous cell papillomas are a result of infection with human papillomavirus (HPV).


Oral squamous cell papilloma

Oral squamous cell papilloma

  • Squamous cell papilloma of the mouth or throat is generally diagnosed in people between the ages of 30 and 50, and is normally found on the inside of the cheek, on the tongue, or inside of lips. Oral papillomas are usually painless, and not treated unless they interfere with eating or are causing pain. They do not generally mutate to cancerous growths, nor do they normally grow or spread. Oral papillomas are most usually a result of the infection with types HPV-6 and HPV-11


Treatment1

Treatment

  • While most cases require no treatment, therapy options include cryotherapy, application of a topical salicylic acid compound, surgical excision and laser ablation.


Squamous papilloma

Squamous Papilloma


Quick review

Quick Review

  • The papilloma is a benign mucosal mass produced by a strain of the papillomavirus, the virus which produces skin warts. It seldom is large but may become a couple of centimeters across. It is painless, usually white but sometimes pink, and has long or short surface projections with rounded or pointed ends. It often is on a stalk and only one lesion is usually found. Once present, it remains indefinitely. In the throat a similar lesion may occasionally go on to cancer, but in the mouth this has never been reported. The papilloma is not contagious, like a wart, and can be removed by conservative surgery or laser destruction.


Keratoacanthoma

Keratoacanthoma

  • Keratoacanthoma (KA) is a common low-grade (unlikely to metastasize or invade) skin tumour that is believed to originate from the neck of the hair follicle.


Keratoacanthoma1

Keratoacanthoma.


Etiology

Etiology

  • The tumors usually occur in older individuals (mean age 64 years old). Like squamous cell cancer, data suggests ultraviolet light from the sun causes the development of KA.[9] Just like its close relative, the squamous cell cancer, sporadic cases have been found co-infected with the human papilloma virus (HPV)


Diagnosis

Diagnosis

  • Diagnosis is best done with clinical exam and history. It presents as a fleshy, elevated and nodular lesion with an irregular crater shape and a characteristic central hyperkeratotic core. Usually the patient will notice a rapidly growing dome-shaped tumor on sun-exposed skin


Skin keratoacanthoma whole slide

Skin keratoacanthoma whole slide.


Treatment2

Treatment

  • On the trunk, arms, and legs, electrodesiccation and curettage often suffice. Excision of the entire lesion is often required if one wants to confirm the clinical diagnosis of keratoacanthoma. On the nose and face, Mohs surgery allows for good margin control with minimal tissue removal; unfortunately, many insurance companies require the correct diagnosis of a malignancy before allowing such procedure. Recurrence after electrodesiccation and curettage is common, and usually can be identified and treated promptly with either further curettage or surgical excision. Allowing the KA to grow and necrose spontaneously is not acceptable in today's standard of care.


Bowen s disease

Bowen's disease

  • Bowen's disease (BD) (also known as "squamous cell carcinoma in situ"[1]:655) is a neoplastic skin disease, it can be considered as an early stage or intraepidermal form of squamous cell carcinoma. It was named after Mark Bowen. Erythroplasia of Queyrat is a form of squamous cell carcinoma in situ arising on the glans or prepuce, possibly induced by HPV


Bowen s disease as seen under a microscope

Bowen's disease as seen under a microscope


Causes1

Causes

  • Causes of BD include solar damage, arsenic, immunosuppression (including AIDS), viral infection (human papillomavirus or HPV) and chronic skin injury and dermatoses.


Signs and symptoms1

Signs and symptoms

  • Bowen's disease typically presents as a gradually enlarging, well demarcated erythematous plaque with an irregular border and surface crusting or scaling. BD may occur at any age in adults but is rare before the age of 30 years - most patients are aged over 60. Any site may be affected, although involvement of palms or soles is uncommon. BD occurs predominantly in women (70-85% of cases). About 60-85% of patients have lesions on the lower leg, usually in previously or presently sun exposed areas of skin.


Histology

Histology

  • Bowen's disease is essentially equivalent to squamous cell carcinoma in situ. Atypical squamous cells proliferate through the whole thickness of the epidermis. The entire tumor is confined to the epidermis and does not invade into the dermis. The cells in Bowen's are often highly atypical under the microscope, and may in fact look more unusual than the cells of some invasive squamous cell carcinomas.


Treatment3

Treatment

  • Photodynamic therapy (PDT), Cryotherapy (freezing) or local chemotherapy (with 5-fluorouracil) are favored by some clinicians over excision. Because the cells of Bowen's disease have not invaded the dermis, it has a much better prognosis than invasive squamous cell carcinoma. Outstanding results have been noted with the use of imiquimod for Bowen's disease of the skin, including the penis (erythroplasia of Queyrat), although Imiquimod is not FDA approved for the treatment of squamous cell carcinoma


Additional images

Additional images


Actinic keratosis

Actinic keratosis

  • Actinic keratosis (also called "solar keratosis" and "senile keratosis") is a premalignant condition of thick, scaly, or crusty patches of skin.:719 It is more common in fair-skinned people. It is associated with those who are frequently exposed to the sun, as it is usually accompanied by solar damage. Since some of these pre-cancers progress to squamous cell carcinoma,they should be treated. Untreated lesions have up to twenty percent risk of progression to squamous cell carcinoma


Actinic keratosis on the lip

Actinic keratosis on the lip


Classification

Classification

  • Hyperkeratotic actinic keratosis

  • Pigmented actinic keratosis

  • Lichenoid actinic keratosis

  • Atrophic actinic keratosis


Prevention

Prevention

  • Not staying in the sun for long periods of time without protection (e.g., sunscreen, clothing, hats).

  • Frequently applying powerful sunscreens with SPF ratings greater than 30 and that also block both UVA and UVB light.

  • Wearing sun protective clothing such as hats, long-sleeved shirts, long skirts, or trousers.

  • Avoiding sun exposure during noon hours is very helpful because ultraviolet light is the most powerful at that time.


Diagnosis1

Diagnosis

  • Doctors can usually identify AK by doing a thorough examination. A biopsy may be necessary when the keratosis is large and/or thick, to make sure that the bump is a keratosis and not a skin cancer. Seborrheickeratoses are other bumps that appear in groups like the actinic keratosis but are not caused by sun exposure, and are not related to skin cancers. Seborrheickeratoses may be mistaken for an actinic keratosis


Histopathology

Histopathology

  • Actinic keratosis usually shows focal parakeratosis with associated loss of the granular layer, and thickening of the epidermis. The normal ordered maturation of the keratinocytes is disordered to varying degrees, there may be widening of the intracellular spaces, and they may also have some cytologicatypia, such as abnormally large nuclei. The underlying dermis often shows severe actinic elastosis and a mild chronic inflammatory infiltrate


Treatment4

Treatment

  • Diclofenac sodium 3% gel, a nonsteroidal anti-inflammatory drug[6]. Recommended duration of therapy is 60 to 90 days.

  • Cryosurgery, e.g. with liquid nitrogen, by "freezing off" the AKs

  • 5-fluorouracil (a chemotherapy agent): a cream that contains this medication causes AKs to become red and inflamed before they fall off

  • Photodynamic therapy:[8] this new therapy involves injecting a chemical into the bloodstream, which makes AKs more sensitive to any form of light[9].

  • Laser, notably CO2 and Er:YAG lasers. A Laser resurfacing technique is often used with diffuse AKs.

  • Electrocautery: burning off AKs with electricity

  • Immune Response Modifier: topical treatment with imiquimod[10] (Aldara), an immune enhancing agent

  • Different forms of surgery


Cutaneous horn

Cutaneous horn

  • Cutaneous horns, also known by the Latin name cornucutaneum, are unusual keratinous skin tumors with the appearance of horns, or sometimes of wood or coral. Formally, this is a clinical diagnosis for a "conical projection above the surface of the skin." They are usually small and localized, but can in very rare cases be much larger. Although often benign, they can also be malignant or premalignant.


Etiology1

Etiology

  • The cause of cutaneous horns is still unknown, but it is believed that exposure to radiation can trigger the condition. This is evidenced by a higher rate of cases occurring on the face and hands, areas that are often exposed to sunlight. Other cases have reported cutaneous horns arising from burn scars. As with many other wart-like skin conditions, a link to the HPV virus family, especially the HPV-2 subtype has been suggested.


Prominent cases

Prominent cases

  • Zhang Ruifang, aged 101 (living in Linlou Village, Henan province, China), has grown a cutaneous horn on her forehead, resembling what those who have examined her and her family call "Devil's Horns." Notably, this growth has expanded to reach a total of 6 centimeters in length. Another is forming on the opposite side of her forehead.[5]

  • Madame Dimanche, called Widow Sunday, a French woman living in Paris in the early 19th century, grew, in six years from the age of 76, a 24.9 cm (9.8") horn from her forehead before it was successfully removed by French surgeon Br. Joseph Souberbeille (1754–1846). A wax model of her head is on display at the Mütter Museum, The College of Physicians of Philadelphia, US


Mortality morbidity

Mortality/Morbidity

  • The lesion at the base of the keratin mound is benign in the majority of cases. Malignancy is present in up to 20% of cases, with squamous cell carcinoma being the most common type. The incidence of squamous cell carcinoma increases to 37% when the cutaneous horn is present on the penis.[7] Tenderness at the base of the lesion is often a clue to the presence of a possible underlying squamous cell carcinoma.


Treatments

Treatments

  • As the horn is composed of keratin, the same material found in fingernails, the horn can usually be removed with a sterile razor.

  • However, the underlying condition will still need to be treated. Treatments vary, but they can include surgery, radiation therapy, and chemotherapy.


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