3. Basic Disease Processes
Etiology (Cause ex.mycobact. Tuberc.)
Pathogenesis`
(Mechanisms:inflammation)
Clinical Features (Signs and Symptoms)
Fever, cough, sputum, abnormal xray

4. Signs of Disesase Measurable / Observable
Examples: Fever, Bleeding, “Lesions”
Phsical evidence of disease processes.

5. Clinical Area of Abnormality Associated with Disease / Disease Process
“Lesions”
Clinical Area of Abnormality Associated with Disease / Disease Process
Lesions: generic term for an abnormality. Blueish grey to black macule is what this one.

6. Symptoms of Disease Subjective Example: Pain, Paresthesia
Signs can be observed and or measured. Symptoms cannot.

7. Basic Disease Processes Pathogenetic Mechanisms - M I N D -
M etabolic - Hormonal; Nutritional
Example: Diabetes Mellitus
I nflammatory - Infection, Immunologic
Examples: Tuberculosis, Pemphigus
N eoplastic - Any Neoplasm, Benign or Malignant
Examples: Papilloma, Squamous Cell Carcinoma
D evelopmental - Genetic or Acquired Malformation
Example: Mandibular Torus
No need to memorize this right now. Couldn’t hurt, though.

8. Evaluation and Characterization of Soft Tissue “Lesions”
1. Type of “Lesion”
2. Color of “Lesion” (Be Specific)
3. Surface Characteristics of “Lesion”
4. Palpable Features of “Lesions”
5. Attachment of “Lesions”
ALSO NOTE:
1. Size (in mm. or cm. or compared to known object - “dime-sized” or “grape sized”)
2. Specific Location of Lesion (Using Oral Togography)
3. Number of lesions (if more than one)
AND:
1. History : Duration and Changes and Rate of Changes
2. Symptoms: Asymptomatic (ASX), Pain, Tenderness

9. Types of “Lesions” plaque nodule cyst FLAT LESIONS
Macule
Plaque
Ulcer
Swellings (Solid Tissue)
Papule
Nodule
Tumor
Swellings (Fluid-Filled)
Vesicle
Bulla
Pustule/Abscess
Cyst
Combinations of Types
plaque
nodule
cyst

10. FLAT LESIONS Macule Plaque Ulcer
Amalgam tattoo is a macule. You can see it but not feel it. Plaque is barely raised.

11. TYPE - Macule
A flat lesion - color change ONLY - Not paplable at all !!
When examining Indicate Specific Color
This macule is an Amalgam Tattoo
Description: A Single 8x10 mm. Bluish-Grey pigmented macule
of the left mandibular buccal edentulous alveolar ridge mucosa (missing #19 area)
People with addisons disease get a lot of macules “freckles” in the mouth.
8 mm.
10 mm.

12. TYPE - Plaque A flat and slightly raised lesion: palpable
Some may be Wiped Off
Usually white
Often a thickening of the keratin surface
This plaque is a “pre-cancerous” epithelial dysplasia
Description: A single 8x12 mm. irregular shaped rough surfaced leukoplakia (non-wipable white plaque) of the right lateral tongue.

13. TYPE - Ulcer Localized area of complete loss of surface epithelium
Crusted/Scabbed on skin - Pseudomembrane intraorally
Often Painful
May be result of trauma, infection, cancer or other disease
These two ulcers are “Canker Sores / Aphthous Ulcers”
Pseudomembrane overlying
Exposed Connective Tissue

14. TYPE - Ulcer / Other Examples
Both of these lesions are
Squamous Cell Carcinomas

15. SWELLINGS (Solid Tissue) Categorized by Size
Papule
~1-2 mm
Nodule
< 1 cm
Tumor
> 1 cm

16. Papule (Solid Tissue Swelling)
Small (1-2 mm) Swelling of Solid Tissue
These Papules are Fordyce Granules (Ectopic Sebaceous Glands)
Solid tissue

17. Nodule (Solid Tissue Swelling)
“Larger” ( up to 1 cm.) Swelling of Solid Tissue
May be Hyperplasia, benign of malignant neoplasm
This Nodule is Hyperplasia - “Pyogenic Granuloma”

18. Tumor (Solid Tissue Swelling)
Larger still (> 1 cm) Swelling of Solid Tissue
May be Hyperplasia or Neoplasm of Epithelium or of Connective Tissue
This Tumor is a Benign Neoplasm of Accessory Salivary Gland Origin - a Pleomorphic Adenoma

19. TYPE - Vesicle (Fluid Filled Swelling)
“Small” < 2 mm. Blister (Fluid Filled and Intraepithelial)
Most commonly the result of viral (Herpes) infection or allergy
These Vesicles are due to Recurrent Herpes simples infection
Intraepithelial Fluid

20. TYPE - Bulla (Fluid Filled Swelling)
“Large” Blister - Fluid Filled and Intraepithelial
Usually Immunopathic Disease - Pemphigus, etc.
This Bulla is the result of Pemphigus Vulgaris
Collapsed Bulla (Ruptured and Fluid
has Escaped)
Intraepithelial Fluid
Residual Ulcers

21. TYPE - Cyst (Fluid Filled Swelling)
Pathologic Cavity / Space
Lined by Epithelium
Usually Filled with Fluid
Swelling in soft tissue -Radiolucency in Jaws
This Cyst is a Mucous Retention Cyst
Fluid
Cyst
Epithelial
Lining
Fluid
Epithelial
Lining

22. Surface Characteristics of “Lesions”
Smooth
Papillary / Verrucous
Ulcerated
Smooth
Papillary
Verrucous
Ulcerated

23. Smooooooth

24. Papillary

25. Ulcerated Loss of Area of Surface Epithelium
Some would consider this a nodule with a cratered ulceration in the middle. Know colors too.
Ulcerated

26. Palpable Characteristics of “Lesions”
Compressible
Fluctuant
Pressure Displaces Fluid
Soft (Solid Tissue)
Firm (Solid Tissue)
Hard
Indurated (Usually applies to Malignancy)
Bony (Hard as Bone)
Fluctuant
Fluid
Usually we just say indurated when we suspect malignancy.
Indurated

27. Attachment of “Lesions” - Soft Tissue Masses -
Pedunculated
Attached by a Narrow Stalk
Sessile
Attached by a Broad Base
Palpation
Movable
Fixed
Pedunculated
Sessile
Moveable is good. Fixed is a bad sign. Got to feel it to know it. Imagine a marble. If it rolls around, that is a good thing.
Movable
Fixed

28. Pedunculated Attached by a Narrow Stalk

29. Sessile Attached to Normal Tissue by a Broad Base

30. ORAL “CANCER” - Any Malignant Neoplasm -
96% “Carcinoma” (Epithelial)
91% “Squamous Cell Carcinoma
Carcinoma: epithelial
Sarcoma: not epithelial. So 4% of malig. Neopl. In mouth are sarcomas.

31. ORAL CANCER Squamous Cell Carcinoma
Invasive Neoplasm of
Malignant Squamous Epithelium
Malignant Squamous Cells
Invading Muscle

32. Clinical Features - Oral SCCA -
Leukoplakia - White Plaque
Erythroleukoplakia -
Red and White Plaque
Erythroplakia - Red Plaque
The more settle the change, the more likely it is early. Cuando el tumor esta mas grande, hay menos posibilidad de prognosis bueno.
Ulcer with Crust / Scab
Tumor with Surface Ulcer

33. ORAL CANCER “TNM” Classification and Staging
Primary Cancer - “T”
Local Metastasis - “N”
(Regional Lymph
Nodes)
(Such as Lung)

34. ORAL CANCER Pre-Malignant Lesions
“Pre-malignant” = Any Lesion with Increased Potential to Become Malignant
Leukoplakia= white plaque
erythroplakie=red plaque
Carcinoma in situ is not malignant.

35. “Premalignant” Lesions”
Leukoplakia
80 % Hyperkeratosis
Transformation ~ 6 %
17-19 % Dysplasia
Increased Transformation Risk
(1-3 % “Early” SCCA)
Erythroplakia/ Erythroleukoplakia
80 + % Dysplasia (or SCCA)
Much Greater Risk of Cancer or Transformation
Leukoplakia
ErythroLeukoplakia
So… translation… 80% of leukop. Are hyperkeratosis – basically a callous – 6% of those can transform into something cancerous. So…red is a whole lot worse than white, generally speaking.
Erythroplakia