Squamous Papilloma

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Squamous Papilloma

• Most common benign epithelial neoplasm seen
  intraorally
• Solitary lesion, typically found on soft
  palate/uvula or tongue
• Finger-like fronds, usually pedunculated, but may
  be sessile
• Range of color (reddish to white)

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Papilloma - Histology

• Orthokeratinized or parakeratinized surface
• Papillary proliferation of surface epithelium
• Finger-like projections of fibrous connective
  tissue that support the epithelial proliferation

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Papilloma - Treatment

• Conservative excision, including the base of the
  lesion
• Prognosis is excellent
• Recurrences are uncommon no risk of malignant
  transformation

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Verruca Vulgaris

• Common lesion caused by several strains of human
  papillomavirus
• Frequently affects children - hands and facial
  skin
• Usually sessile, exophytic, papillary lesion
  often multiple

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Verruca Vulgaris

• Papillary hyperkeratotic epithelial proliferation
• Alternating zones of orthokeratin and parakeratin
• Cupping in of the lesional rete ridges
• Coarse, clumped keratohyaline granules
• Koilocytosis

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Verruca Vulgaris

• spontaneous regression is common in kids
• excision, cryotherapy, keratolytic agents
• may recur

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Condyloma Acuminatum

• also known as venereal warts
• caused by several strains of HPV, including types
  6, 11, 16 and 18
• oral lesions - multiple, sessile, cauliflower
  surface

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Condyloma Acuminatum

• papillary proliferation with slight parakeratin
  production
• broad, confluent rete ridges
• abundant mitoses koilocytosis
• molecular evidence of HPV

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Condyloma Acuminatum

• excision, cryotherapy, laser excision
• recurrence is common - 30 of patients have
  recurrent lesions after each treatment episode
• associated with squamous cell carcinoma of the
  uterine cervix

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Seborrheic Keratosis

• very common cutaneous lesion
• arises after age 40, on skin of face and trunk
• often multiple, tan-brown to black,
  well-demarcated plaques
• mud thrown against a brick wall

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Seborrheic Keratosis

• proliferation of basaloid and squamoid epidermal
  cells
• totally exophytic growth pattern
• formation of horncysts and pseudo-horncysts
• acanthotic, hyperkeratotic, adenoid types

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Seborrheic Keratosis

• no treatment necessary
• may be removed for cosmetic purposes
• curettage or cryotherapy

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Dermatosis Papulosa Nigra

• variant of seborrheic keratosis
• autosomal dominant tendency, seen in 30 of
  African-Americans
• multiple small dark papules, develop after 20
  years of age
• periorbital skin

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Sebaceous Hyperplasia

• common cutaneous lesion
• facial skin, often multiple
• umbilicated yellowish papule, often lt5 mm
• sebum may be expressed from central pore

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Sebaceous Hyperplasia

• Collection of hyperplastic lobules of sebaceous
  gland
• Ducts empty into the central depressed area

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Sebaceous Hyperplasia

• No treatment is necessary unless removed for
  cosmetic purposes or to rule out basal cell
  carcinoma
• Conservative excision is adequate

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Keratoacanthoma

• controversial lesion rare intraorally
• arises on sun-exposed skin of older individuals,
  especially on the face
• grows rapidly, reaching 2 cm in 6 weeks
• umbilicated nodule with central keratin plug

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Keratoacanthoma

• Histopathologically appears very similar to
  squamous cell carcinoma
• Squamoid cells with atypia appear to
  superficially invade the connective tissue
• Acute angle noted where surface epidermis and
  tumor meet

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Keratoacanthoma

• resolves spontaneously after one year
• surgical excision is often best, though, due to
  unesthetic depressed scar that forms if lesion
  undergoes spontaneous resolution
• some cases are aggressive misdiagnosed SCCa?

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Leukoplakia

• White patch of the oral mucosa that cannot be
  scraped off and cannot be diagnosed clinically or
  microscopically as any other condition
• Clinical term only biopsy is mandatory
• Leukoplakia is considered to be a premalignant
  process

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Things that are not leukoplakia

• Leukoedema
• Cheek chewing
• Frictional keratosis
• Nicotine stomatitis
• Snuff-dippers keratosis

• Aspirin burn
• Candidiasis
• Lichen planus
• White sponge nevus
• Cinnamon reaction

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Leukoplakia

• Older adult males (gt50 years of age)
• Tobacco use, especially cigarettes
• Sharply demarcated white plaque with smooth,
  verrucous or micronodular surface
• If red component is present - speckled
  leukoplakia

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Leukoplakia - Histology

• Typically some degree of hyperkeratosis (wet
  keratin appears white)
• Precancerous changes may be evident
  microscopically epithelial dysplasia
• Mild, moderate, severe dysplasia or
  carcinoma-in-situ

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Leukoplakia

• Treatment is controversial
• No or mild dysplasia - D/C carcinogenic habits
  watch?
• Moderate dysplasia or worse - remove by the most
  convenient means available

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Leukoplakia

• Prognosis is guarded
• 15 of non-dysplastic lesions will transform if
  not treated
• 33 of dysplastic lesions will transform
• 30 of leukoplakias will recur

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Erythroplakia

• A red patch that cannot be diagnosed as any other
  condition clinically or microscopically
• More serious than leukoplakia
• Same epidemiologic features and risk factors
• Velvety red, well-demarcated patch, usually
  affecting the lateral tongue, floor of the mouth
  or soft palate

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Erythroplakia

• Microscopically, 90 of these lesions are severe
  epithelial dysplasia or worse at the time of
  biopsy
• Red appearance is due to the lack of keratin
  production on the surface of the lesion

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Erythroplakia

• Generally more advanced than leukoplakia when
  initially detected
• Treatment and prognosis are similar for that of
  leukoplakia having a similar degree of epithelial
  dysplasia

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Actinic Keratosis

• Premalignant sun-induced skin lesion
• Common on facial skin and vermilion zone of the
  lips in fair-skinned persons over 40 years of age
• Caused by ultraviolet light exposure
• Scaly plaque with sandpaper texture

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Actinic Keratosis

• Hyperkeratosis, usually parakeratin
• Some degree of epithelial dysplasia or even
  superficially invasive squamous cell carcinoma
  seen histopathologically

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Actinic Keratosis

• Skin lesions treated with topical liquid
  nitrogen, surgical excision, laser ablation or
  5-fluoro-uracil (Effudex)
• Prognosis is fair to good
• Patient must be monitored for development of new
  lesions, however

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Actinic Cheilosis (Cheilitis)

• Term for actinic keratosis involving the
  vermilion zone of the lower lip
• Chronic scaling, crusting, ulceration and/or
  fissuring of the lip may be seen

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Actinic Cheilosis - Tx

• Vermilionectomy with advancement of the labial
  mucosa or laser ablation of the involved
  vermilion zone may be done

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