Etiology: Clinical Dx: S/S:

Tobacco:
Pipe Nicotine -Hard palate ONLY
smokingheat Stomatitis -White thickening w/ red
spots at salivary gland
openings=pathognomonic!
-No risk of malignancy

Chewing Smokeless -MD vestibule

tobacco/snuff Tobacco -M>F, 9-15 yo.
Keratosis -Pale pink/white, wrinkled
granular surface=mucosal
dysplasia
-Asymptomatic
-Taste s, perio dz w/
recession, dental erosion
and caries
-Malignancy=0.4%

Chewing Verrucous -Buccal vestibule 50%

tobacco/snuff Carcinoma -Gingiva 30%
-Slow growing
-Smoothextensive white
surface, nodular/papillary
forms
-Rarely metastasizes; great
prognosis
 Cigarette Smokers -MD ant. gingiva, buccal
smoking Melanosis mucosa
-Brown patches several cms
 Oral -Movable mucosa
Smoking Candidiasis -White stuck-on plaques
oral environ. -May bleed when wiped off

Betel quid Oral -Mucosal rigidity

(India and SE Submucous -Palate blanching
Asia) Fibrosis -Burning,
trismusmicrostomia
-SCC=6%

HPV infection:
Types 6, 11 Squamous -Palate and uvula
Papilloma -Cauliflower-like, short
blunt projections
-Pedunculated
-Painless, incidental findings
-Adults
 Types 2, 4, 6, Verruca -Vermillion lip, ant. tongue,
40 Vulgaris hands/fingers
-Longer projections, spikey
-ALWAYS see cellular s=
koilocytes (balloon cells)
-Pre-malignant
-YAs and kids

STD of Types Condyloma -Rare intraoral, usually

6, 11 Accuminata anogenital skin
-Larger than other warts;
mushroom-shaped
Types 13, 32 Multifocal -Lower lip; ONLY intraoral
Epithelial -Multiple lesions
Hyperplasia -Flattened, persistent
nodules, same color as
mucosa
-Native American lineage
Sun/UV
exposure:
Actinic -Chapped lips doesnt heal
Cheilitis/Ker w/ chapstick
atosis -White and smooth, crusty
scales
-Blended border b/w
vermillion lip and skin
-Older Caucasians
-Malignancy: 13-25%

Squamous -Lower lip 35% (NOT

Cell intraoral)
Carcinoma -Lat/ventral tongue 25%
-Floor mouth 20%
-Most common oral cancer
-Fixed to tissue, indurated,
rolled borders
-Mucosal lesion w/ tooth
mobility
Keratoacant -Lips 8%
homa (?) -Rarely intraoral
-Elevated crateriform w/
depressed central plug
-Looks like SCC
-Behavior=diagnostic
1) Rapid growth 4-8 wks.
2) Stationary 4-8 wks.
3) Spontaneous involution

Basal Cell -Mid/upper face; NEVER

Carcinoma intraoral
-Most common skin cancer
80%
-Early: pimple that doesnt
heal
-Late: small, scaly w/ rolled
borders, bleeding ulcers
-No metastasis, excellent
prognosis
-95-98% cure w/ tx

Malignant -Vermillion lip or head/neck

Melanoma -#3 most common skin
(NOT oral) cancer
-83% of skin cancer deaths
SALIVARY GLAND

Site
o Palate
Necrotizing Sialometaplasia (almost always palate @junction)
Tender swellingulceration
Spontaneous resolution in 6-10 wks.
Benign Mixed Tumor
Very round and firm
Mucoepidermoid Carcinoma
Polymorphous Low Grade Adenocarcinoma
Histo: concentric cells in Indian file around b.v.s and nn.
o Lower lip
Mucous Escape Reaction (@wet/dry line)
Bluish/clear vesicle; inflamm. w/ no epith. Lining
Cheilitis Glandularis
Tiny red dots; suppuration/ulceration; slow onset
o Upper lip
Canalicular Adenoma
Pinkish/bluish mobile mass; over 60 yo.
Histo: party wall double rows of cells
PLGA (2nd most common site)
o Whartons/Submand. Duct
Mucus Retention Cyst
Firmer than MER; no inflamm. but epith. lined cavity filled with mucus
Sialolithiasis
Pain, sudden gland enlargement @mealtimes; hard nodule
X-ray: opaque mass on MD
o Parotid Gland/front of ear
Sjogren Syndrome
Xerostomia + keratoconjunctivitis sicca; abnormal taste
85% F, middle-aged
Bilateral parotid swelling if present
Sialosis
No mass effect, generalized fullness
Acinic Cell Adenocarcinoma (85-90%)
Painful!
Mammary Analogue Secretory Carcinoma (58%)
Painless mass; hx: present for yrs.
o Submandibular Gland
Adenoid Cystic Carcinoma (12-17%)
Most common Submand. Malignancy
BONE