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6 questions for lesion history
- 1. How long has it been present?
- 2. Has it changed in size? (rate important)
- 3. has it changed in character? (lump-->ulcer)
- 4. Any symptoms? (inflammation, tingling)
- 5. Any constitutional problems? (fever, sore throat)
- 6. Historic reason for lesion
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Components of lesion clinical exam
- 1. Anatomic location
- 2. Size and shape
- 3. Single or multiple
- 4. Surface
- 5. Color
- 6. Boundaries
- 7. Consistency upon palpation
- 8. Any pulsation?
- 9. Lymph node exam
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Biopsy indications
- 1. Present for more than 2 weeks and no etiologic basis
- 2. No response to local treatment after 10-14 days
- 3. Persistent hyperkeratotic changes in the surface tissue
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Suspicious indications of malignacncy
- 1. Erythroplasia
- 2. Ulceration
- 3. Duration/ Growth rate
- 4. Bleeding
- 5. Induration/fixation
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Types of biopsies
- 1. Oral cytology
- 2. Aspiration biopsy
- 3. Incisional biopsy
- 4. Excisional biopsy
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Characteristics of biopsy
- 1. Take a narrow deep wedge to show full pathologic process
- 2. Capture the margin of the tissue (transition from normal)
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Vesicular-ulcerated erythematous surface lesions
- 1. Herpes-Simplex
- 2. Varicella Zoster
- 3. Candidosis
- 4. Benign mucous membrane pemphigoid
- 5. Bullous pemphigoid
- 6. Pemphigus
- 7. Lupus Erythematosus
- 8. Apthous Ulcers
- 9. Erosive Lichen Planus
- 10. Erythema Multiforme
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Soft tissue enlargements
- 1. Hemangioma
- 2. Lymphangioma
- 3. Fibroma
- 4. Lipoma
- 5. Neuro-fibroma
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When can we use full excisional biopsy?
- When the lesion is smaller than 1 cm
- Cut through mucosa down to the muscle
- Wedge elliptical shape includes both lesion and normal tissue
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Which types of lesions blanch?
Vesicular lesoins
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The most common salivary gland disease
Pleomorphic adenoma
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The most common malignant salivary gland disease
Mucoepidermod carcinoma in the hard palate
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Adenoid cystic carcinoma
- Invades neural tissue
- Poor prognosis
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The most common minor salivary gland disease
Polymorphous low grade adenocarcinoma
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Intra Osseous Lesions
- 1. Ameloblastoma (most common odontogenic tumor)
- 2. Keratocyst
- 3. Central Giant Cell Granuloma
- 4. Anuerysmal bone cyst
- 5. Myxoma
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Intra-osseous cyst lesions
- 1. Lateral periodontal cyst
- 2. Radicular cyst and periapical granuloma
- 3. Hyperplastic Dental Follicle
- 4. Follicular Cysts (dentigerous and primordial)
- 5. Odontogenic Keratocyst
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Types of fluid to place biopsy specimen
Formalin or formaldehyde
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What should we conduct first before biopsying?
A lymph node exam (avoid metastasis assumption)
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Does a bone biopsy take longer than a soft tissue biopsy?
yes, they have to decalcify first
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What are the different types of biopsies?
- 1. Cytology (cell scraping, many false negatives)
- 2. Aspiration (often with bony lesions, insert needle)
- 3. Incisional (only a portion of tissue, extensive/malignant lesions)
- 4. Excisional (<1cm, benign lesions)
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