accounts for >90% of oral cavity cancers
minimal pain
seen more commonly in males 65+
presents as an indurated/hard lesion, fixed to underlying structures, will have "rolled" border if ulcerated and may destroy the underlying bone
Squamous cell carcinoma
What is the most common site for SCC in the ORAL cavity ?
Other location of SCC
Tongue (posterior lateral and ventral surfaces)
Gingiva--may cause bone destruction and present at the site of an extraction site
initial symptoms may be dysphagia and pain
more difficult to see and diagnose so most cases are in late stages
majority associated with high risk HPV (16,18,33)
Oropharyngeal SCC
What is the best predictor of prognosis of oral cancer?
Staging (based on tumor size and metastatic spread)
SCC mainly metastasizes though ____
lymph nodes (ipsilateral)
50% of SCC patients have ____ ___ ___ at the time of diganosis
Positive cervical nodes
what is a characteristic microscopic feature of SCC?
keratin curls
the ___ grade usually associated with ___ prognosis
Higher
Poorer
well-diff (low-grade)
poorly-diff (high-grade)
Low grade variant of SCC
AKA snuff dipper's cancer (more common in smokeless tobacco users but not exclusive)
Presents as painless and slow growing, papillary or veracious surface, usually white in color
Verrucous carcinoma
T/F: Verrucous carcinoma has a very low chance of metastasis
TRUE!
a type of carcinoma that is related to salt fish with nitrosamines and EBV as causes
More common in males ages 40-60 First sign of disease for most patients is enlarged cervical lymph nodes
Symptoms: epistaxis, nasal obstruction, pharyngeal pain
Nasopharyngeal carcinoma
What are the three types of microscopic features of nasopharyngeal carcinoma
SCC
Non-Keratinizing SCC
Undifferentiated/poorly differentiated (must use special stains to identify cytokeratins, almost all occur inpatients younger than 40)
How is nasopharyngeal carcinoma treated?
Radiation (due to inaccessibility and presentation with metastasis)
80% of all skin cancers (85% in the head and neck region)
Results from chronic exposure to UV light NOT found in the oral cavity
Basal Cell Carcinoma
Where and who is most affected by basal cell carcinoma
Fair-complexioned Caucasians
most commonly on the sun-damaged skin of the middle third of the face
Begins as firm, painless papule and enlarges and develops central depression
Boarder is smooth, elevated rolled and shiny or pearly
Telangiectasia is often present
Basal cell carcinoma--nodular form
Nodular BCC colonized by benign melanocytes
usually irregular distribution of pigment (unlike a nevus)
Basal cell carcinoma--pigmented form
"morpheaform"--like localized scleroderma
mimics scar tissue
firm to palpation, with indistinct boarder
Basal cell carcinoma--sclerosing form
Well-demarcated, erythematous, scaly patches can be mistaken for psoriasis
have a narrow and raised edge and usually multiple present
Basal cell carcinoma--superficial
Which basal cell form?
___1___ dense connective tissue with infiltrating strands of basal cells
___2____multiple lobules of basal cells dropping from the surface
1. Sclerosing
2. Superficial
Most malignant cancer (third most common cancer)
Arises from melanocytic nevi or de novo
Risk factors: sun exposure, light complexion, family history, past Hx
Melanoma
T/F: rates of melanoma are decreasing over the past few decades
FALSE they are INCREASING
Which type of melanoma is rare?
Oral melanoma
occasionally presents as mets from skin to parotid
ABCDs of clinical presentation
A: Asymstrical
B: boarders are irregular, notched, indistinct
C: color is brown, black, pink, red, blue, white
D: diameter is greater than 6 mm
Growth stages
1. usually early stages
2. nodular and later stages
Radial growth
Vertical growth
what is the most common form of melanoma
Superficial spreading
presents as a colored macule or low papule (usually <3 cm)
type of melanoma that immediately begins with vertical growth phase
elevated and deeply pigments
1/3 develop on the head and neck
Melanoma
Precursor of this disease is lentigo maligna and the present of modularity in the lentigo maligna makes it this disease
this is a radio phase melanoma in situ seen in fair skinned old people
Lentigo Maligna Melanoma
Most common form of melanoma in blacks
Found on soles of feet, under nails, mucosa, palms most common form of oral melanoma
Presents as a darkly pigmented, irregular marginated macule that later develops nodular, invasive growth phase
Acral Lentiginous melanoma
Patient usually in 50s to 60s
2/3 of patients are male
80% on hard palate or maxillary alveolus
Looks like other melanomas
May show “moth-eaten” bone destruction
Mucosal Lentiginous Melanoma
What three stains are used for amelanotic melanomas?
S-100
MART-1
HMB-45
what is the most important prognostic indicator of cutaneous melanoma?
