A condition that presents as painless, raised white patches on ...

[Jipu 123]

A condition that presents as painless, raised white patches on the oral mucosa that predisposes to squamous cell carcinoma is:
 
  A. Candida
  B. Lichen planus
  C. Coxsackie virus
  D. Leukoplakia

Question 2

Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is:
 
  A. Malignant melanoma
  B. Squamous cell carcinoma
  C. Aphthous ulceration
  D. Behcet's syndrome

[soda0602]

Answer to Question 1

ANS: D
The cause of most episodes of leukoplakia is not determined. However, this condition, which results in the development of painless, raised white patches on the oral mucosa, is associated with an increased risk of oral squamous cell cancer. Risk factors for the development of leukoplakia include chronic/recurrent trauma to the affected site and the use of smokeless and smoked tobacco and alcohol.

Answer to Question 2

ANS: B
Most oral malignancies are painless until quite advanced, so patients are often unaware of the lesion unless the lip or anterior portion of the tongue is involved. The patient may become aware of the lesion if it bleeds. Squamous cell cancer lesions vary in appearance, from the reddened patches of erythroplakia to areas of induration/thickening, ulceration, or necrotic lesions. Lesions of malignant melanoma have varied pigmentation, including brown, blue, and black. Even lesions that appear flat and smooth may be nodular, indurated, or fixed to adjacent tissue on palpation. Even though patients with squamous cell malignancies often have a history of heavy alcohol and/or tobacco use or poor dentition, these are not risk factors for malignant melanoma. In Behcet's syndrome, the patient complains of recurrent episodes of oral lesions that are consistent with aphthous ulcers. The number of lesions ranges from one to several; the size of the ulcers varies from less than to greater than 1 cm. Like aphthous ulcers, the lesions are well defined, with a pale yellow or gray base surrounded by erythema. The majority of patients also develop lesions on the genitals and eyes.