Dent 355 Oral Pathology Dent 355 Oral Pathology Laboratory Session Laboratory Session Oral Epithelial Tumors, Oral Epithelial Tumors, Melanocytic Nevi, and Melanocytic Nevi, and Melanoma Melanoma Dr. Rima Safadi Dr. Rima Safadi Oral and Maxillofacial Oral and Maxillofacial Pathologist Pathologist Modified from Dr. Huda Hammad Modified from Dr. Huda Hammad
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Squamous Cell Carcinoma:Squamous Cell Carcinoma:Clinical Presentation, Early LesionsClinical Presentation, Early Lesions
1. White patch.1. White patch. 2. Small exophytic growth 2. Small exophytic growth which in early stages which in early stages shows no ulceration or shows no ulceration or erythemaerythema
Squamous Cell Carcinoma:Squamous Cell Carcinoma:Clinical Presentation, Early LesionsClinical Presentation, Early Lesions
5. Carcinoma of vermilion border of lip: slightly 5. Carcinoma of vermilion border of lip: slightly raised swelling, or crusty, inconspicuous lesion raised swelling, or crusty, inconspicuous lesion resembling delayed healing of herpes labialis.resembling delayed healing of herpes labialis.
Advanced lesions may Advanced lesions may present as:present as:
1. Broad-based, 1. Broad-based, exophytic mass with exophytic mass with rough, nodular, warty, rough, nodular, warty, hemorrhagic, or hemorrhagic, or necrotic surface.necrotic surface.
2. Deeply destructive, 2. Deeply destructive, crater-like ulcer with crater-like ulcer with raised, rolled everted raised, rolled everted edges.edges.
Squamous Cell Carcinoma:Squamous Cell Carcinoma:Clinical Presentation, Advanced Clinical Presentation, Advanced LesionsLesions3. Infiltration of musculature may 3. Infiltration of musculature may
result in functional disturbances result in functional disturbances including impaired speech and including impaired speech and difficult swallowing.difficult swallowing.
4. Pain may be a feature.4. Pain may be a feature.
Invasion and destruction of Invasion and destruction of local tissues accounts for local tissues accounts for induration and fixation induration and fixation detected clinically.detected clinically.
Cytologically malignant Cytologically malignant squamous epithelium with squamous epithelium with variable degrees of variable degrees of differentiation.differentiation.
Keratinization variesKeratinization varies with with degree of differentiation.degree of differentiation.
Very well differentiated, Very well differentiated, heavily keratinized SCC with heavily keratinized SCC with little or no cytological atypia.little or no cytological atypia.
Although it is an exophytic tumor, it also has a Although it is an exophytic tumor, it also has a slowly advancing, slowly advancing, pushing, cohesive invasive pushing, cohesive invasive frontfront causing local destruction. causing local destruction.
A term used to describe A term used to describe severe epithelial severe epithelial dysplasia in which the dysplasia in which the whole, or almost the whole, or almost the whole thickness of whole thickness of epithelium is involved, epithelium is involved, but basement but basement membrane is intact and membrane is intact and there is no invasion of there is no invasion of lamina propria.lamina propria.
Usually presents Usually presents clinically as clinically as leukoplakia or leukoplakia or erythroplakia.erythroplakia.
In some patients it In some patients it may progress to may progress to invasive carcinoma, invasive carcinoma, but in others it may but in others it may remain static or even remain static or even regress.regress.
Oral Premalignant Lesions and Oral Premalignant Lesions and ConditionsConditions
The following may be The following may be considered premalignant considered premalignant lesions or conditions:lesions or conditions:
homogeneous, non-homogeneous, non-homogeneous, nodular, homogeneous, nodular, and speckled types, and speckled types, including chronic including chronic hyperplastic candidosis hyperplastic candidosis and proliferative verrucous and proliferative verrucous leukoplakia.leukoplakia.
b)b) erythroplakiaerythroplakiac)c) carcinoma carcinoma in situin situ..
c)c) actinic keratosis or cheilitis.actinic keratosis or cheilitis.
d)d) other conditions associated other conditions associated with oral epithelial atrophy, with oral epithelial atrophy, e.g. sideropenic dysphagia.e.g. sideropenic dysphagia.
of malignant basaloid of malignant basaloid cells arranged in cells arranged in various patterns , various patterns , invading adjacent invading adjacent tissues.tissues.
Variable melanin Variable melanin production, may be absent production, may be absent (amelanotic melanoma).(amelanotic melanoma).
Immunohistochemical Immunohistochemical studies using specific studies using specific markers for malignant markers for malignant melanocytes (S-100 and melanocytes (S-100 and HMB-45) are useful.HMB-45) are useful.
Ultrastructural examination Ultrastructural examination to identify immature to identify immature melanosomes can be used.melanosomes can be used.