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Hairy leukoplakia

Hairy leukoplakia. Distinctive oral lesion Seen in immunocompromised patients 80% of patients with hairy leukoplakia have HIV infection. Hairy leukoplakia. Takes the form of White or black Confluent Patches of Fluffy (hairy) Hyperkeratotic thickenings

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Hairy leukoplakia

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  1. Hairy leukoplakia • Distinctive oral lesion • Seen in immunocompromised patients • 80% of patients with hairy leukoplakia have HIV infection

  2. Hairy leukoplakia • Takes the form of • White or black • Confluent • Patches of Fluffy (hairy) • Hyperkeratotic thickenings • Almost always on the lateral border of the tongue

  3. Hairy Leukoplakia

  4. Squamous Cell Carcinoma • Oral Cavity

  5. Squamous Cell Carcinoma • 95% of cancers of Head and Neck are Squamous Cell Carcinomas arising most commonly in the oral cavity • Head and Neck Squamous Cell Carcinoma - HNSCC • HNSCC is the 6th most common cancer in the world today • Long term survival is 50%

  6. Squamous Cell Carcinoma • Long term survival is only 50% because • Oral cancer is diagnosed in advanced state • Frequent development of multiple primary tumours

  7. Squamous Cell Carcinoma • Pathogenesis • Multifactorial • North America and Europe - • Middle aged men • Chronic abusers of smoked tobacco • Family history • HPV infection • Actinic radiation - Sunlight (lower lip)

  8. Squamous Cell Carcinoma • Pathogenesis • Multifactorial • Outside of North America and Europe - • Chewing of betel quid - Paan in India • Betel quid contains • Areca nut, Slaked lime, Tobacco wrapped in betel leaf

  9. Squamous Cell Carcinoma • Molecular biology • Development of squamous cell carcinoma a multistep process involving a sequential activation of oncogenes and inactivation of tumour suppressor genes in a clonal population of cells.

  10. Squamous Cell Carcinoma • Molecular biology • Loss of chromosomal regions 3p and 9p21 - inactivation of p16 which is a suppressor of cyclin dependent kinase • Loss of chromosome 17p with mutation of p53 tumour suppressor gene • Deletions of 4q, 6p, 8p 11q, 13q, and 14q

  11. Squamous Cell Carcinoma • Morphology • May arise anywhere in the oral cavity • Ventral surface of tongue, floor of mouth, lower lip, soft palate and gingiva • Preceded by premalignant lesions

  12. Squamous Cell Carcinoma • Morphology • Early stages • Raised firm, pearly plaques • Irregular roughened or verrucous thickening • Later • Ulcerated, protruding masses • Irregular, firm, and indurated (rolled) borders

  13. Squamous Cell Carcinoma • Morphology - Histology • Begin as dysplastic lesions • May or may not progress to full thickness dysplasia prior to invasion • Patterns range from • Well differentiated keratinizing • Anaplastic, • Sarcomatoid • Degree of keratinization does not correlate with behaviour

  14. Squamous Cell Carcinoma • Morphology - Histology • Tend to infiltrate locally before metastasizing • Routes of extension depends on primary site • Favored sites of metastasis • Cervical lymph nodes (local metastasis) • Mediastinal lymph nodes (distant metastasis), lungs, liver and bones. (often occult)

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