Oral Erythroplakia

Erythroplakia is a clinical term for a potentially malignant fiery red lesion that cannot be attributed to any particular condition.

Signs and Symptoms

Lesions are usually asymptomatic and isolated, and commonly appear on the floor of the mouth, tongue, soft palate and buccal mucosa. Lesions may appear as smooth, velvety, granular or nodular plaques, often with clear margins.

Kaposi sarcoma

 

Kaposi sarcoma (in AIDS):

Important points to remember about Kaposi Sarcoma

Kaposi's sarcoma is a type of cancer that forms in the lining of blood and lymph vessels.

Kaposi's sarcoma or oral cavity

Kaposi's sarcoma of the skin

Clinical Features

• It is the most common malignancy in AIDS.
• It is associated with the infection with a virus called the Kaposi sarcoma associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV8).
• The commonly affected sites are palate, gingiva, tongue, and oropharynx or the skin of the face and feet.
• It is seen early in the course of the disease. It can sometimes be confused with Bacillary angiomatosis.
• There is a specific histologic stain for Kaposi sarcoma known as Warthin-Starry stain.
• With the use of HAART, incidence of KS is decreasing and soon NHL may become the most common malignancy associated with AIDS.

 

Oral Cancer

Oral cancer is associated with significant morbidity and mortality. Early presentations of oral cancer are usually asymptomatic, whereas late presentations include pain, discomfort, reduced mobility of the tongue, increased mobility of the teeth or an inability to wear dentures. Oral cancer varies in appearance and can mimic many other oral mucosal diseases.

Squamous cell carcinoma of the left anterior ventral surface of the tongue

Squamous cell carcinoma of the left mandibular alveolus

Oral cancer can mimic many other oral mucosal diseases, so early specialist referral is required for investigation and biopsy of any suspicious lesion. 

Any suspicious lesion needs early specialist referral for investigation and biopsy.

Squamous cell carcinoma is the most common oral malignancy, which arises from the epithelium of the oral cavity. Oral squamous cell carcinoma can affect any part of the oral mucosa; however, it most commonly occurs on the lateral surfaces of the tongue, the floor of the mouth or the gingivae. 

Risk factors for oral squamous cell carcinoma  

1. advanced age 
2. male gender 
3. smoking or tobacco use 
4. alcohol use 
5. infection by oncogenic viruses (eg human papillomavirus) 
6. personal or family history of squamous cell carcinoma of the head and neck 
7. history of cancer therapy 
8. prolonged immunosuppression 
9. areca nut (betel quid) chewing. 
10. Genetic susceptibility, environment, occupation and diet may also contribute to the development of oral squamous cell carcinoma. 

Cancers originating from the salivary glands and supporting nonepithelial tissues are less common than squamous cell carcinoma. Metastatic cancers to the oral soft tissues and jawbones commonly originate from primary malignancies in the breast, prostate, kidneys or lungs. Leukaemia and lymphoma may also present in the oral cavity. 

 

The treating specialist should perform the biopsy of an oral mucosal lesion. In rural or remote areas where a delay in specialist review is expected, seek expert advice on biopsy technique. A punch biopsy is not appropriate.

 

References:

1. Therapeutic guidelines (Oral & Dental) 2019