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Scanned by CamScanner
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Scanned by CamScanner
 th e to n gu lip s L e s io
e o r n s o n o th e r a re a s in c lu d in g m u co b Lıc c a l fo ı
ds an d g in g iv a e a re
a s s o c ia te d ith o th e r s o u r c e s
w
o f iı】.Ita tio n su c h tr a u 171 a fro m
as to o th bn sh
ı o r fo o d C h r o n ic
tr a u m a tic u lc e ıs
g e n e ra lly p rĘ se n t a s a lita r y sha lo
ı
so w o 】
' " e e p d is c o n tin u a tio n o f e p ith e liu m
w ith v a r y in g d e g re e s f p e ıip h e ].A l k e r a to s is
o F lo o r o f th e u lc e r is c o v e re d by h ite
a w o r
y e llo w is h tìb r in c lo t U lc e r ı
te d tio
re s u ı
n re p e a te d tr a u lï ia m a y be sym p to tic o r a s y m p to m
m a a tic ,
o fte n ex h ib its an e le v a te d b o rd e r h ic h is firm pa ı
p a tio
w u po
o n n n e lim in a tio n o f th e c a u s a tiv e
ta c to r o lle lc e r h e a ls
n u w ith o r w ith o Lıt s c a r d e p e n d in
g o n th e e x te n t o f th e d a m a ge o c c u r re d
D c n l ln e A s s o c ia te d M u c o sa ıT D
ra u m a e n tu re w e a r in g ca n be r
c a u se a n u m o f a c u te o r
c h ro n ic o ra lm u c o sa l p r o b le m s 1a n g in g fr o m h is to lo g ic a ıto g r o s s c lin ic a l c h a n g e s G ro s s c in ic a l
ı
c h a n g e s in c ı
u de k e r a to tic h y p e r p la s tic in fla m
, m a to r y a n d u lc e ra tiv e le s io n H Uy ĮV
s p e r k Ue ł
raa tL oU sa iı
s i
,
1 3s
ıe g a rd e d a s a n o rm a l a d a p ta tio fu
n to n c tio n a n d re s o lv e o n c e th e ir r ita tio n is re m o v e d T r a u m a tic
u lc e r s g e n e ra lly o c c u r so o n a fte r th e in s e r tio n f d e n tu
o n e w re s T he y o fte n a ppea r o v e r th e s h a r p
bo n y r id g e s h e r e th e
w m u c o sa is sa n d w ic h e d b e tw th e d e n tu
een re an d bo n e ,
u n de r s p ic u le s o r
h ig h s p o ts f de S
o n tu r e s u c h tr a u m a p ro d u c e s e r y th e m a de m
,
o e a an d su b s e q u e n tly u lc e r a t io n
w h ic h g e n e ra ı
ly p r o d u c e s o re n e s s o r
p a in p r e v e n tin g p a tie n ts a co m fo r ta b le m a s tic a t io n C a re fu l
e ı
im in a t io n o r su c h tr a u m a le a d s to co m p le te re s o lu t io n o f th e p r o b ïe n 7 /nun?n?atow p t illu r
w y
H j p e ıp tu s ia (IP H ) is r e a c tiv e fo
a rm o f tis s u e "g r o w th
o v e】 c lin ic a lly p r e s e n t as a d u la r
n o o r

p a p iı
la r y s u r fa c e c o v e r in
p le te ly
g co m o r p a iì ia lly th e a re a o f th e p a ı
a te c o v e re d by th e d e n tu re

A lth o g h th e e x a c t a e t io lo
u
g y is u n kn o w n ,
th e c o n d itio n is m o s t o fte n s u s e c te d to b e
p re ı
a te d to ,

c o n tin u o u s w e a r in f ill fittin g d e n tu r e s ith p o o

g o w r h y g ie n e th a t o fte n c a u s in g tr a u m a to g e th e r
w ith p r e d is p o s itio to C a n d id a l in fe tio n L e s io n s a r e d ir e c tly d
re ı
n c a te to a g e o f th e p a tie n t an d
th e le n g th f d e n tu IP H is lly
o re u sa ge u su a a sy m p to m a tic an d o fte n id e n tifie d d u r in g ro u tin e

c lin ic a l ex am in a tio n V e ry e a ıly le s io m a b s id e th e ir ita tio n is lim in a te d to g e th e r

n s y su on ce e

w ith th e u se o f a n tifu n g a l a g e n ts H o w e v e r , m o r e e s ta b lis h e d ı

e s io n s m a n ee d s u ıg ic a l re m l
y o v a

c u r e t\a ge ,
e \e c \r o s u r g e r y o r c ry o th e r a py E p u lis ßs s u m ı
ım i (in fı
c łm m c llo ] y jìb r o u s hy ll e r p lu s ic ı) \s
a tu m o u r lik e fib r o u s c o n n ec tiv e tis s u e e s io
ı n th a t d e v e lo p s a s a ıe s u lt o f ill fittin g d e n tu re

fla n g e C lin ic a lly it p r e s é n ts as a s e s s ile m a ss in th e s u lc u s w ith s m o o th s tIr th e e a n d n o rm a l

,

m u c o sa l co lo u r an d a ls o tìì a y be e r y th e m a to u s a n d u lc e ra te d T h is is m o st o fte n se e n am o n g

m id d le a ge d an d o ld e r a d u lts o c c u rT in g e ith e r in r e la tio n to th e m a n d ib le o r m ax illa an d s ho w s a

fe m a le p r e d ile c tio n T r e a tm e n t is o n e n in v o lv e d w ith e x c is io n o f th e le s io n w ith v e s tib u lo p la s ty

an d c o l丁e c tio n o f th e d e n tu re

夕
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 L e u ko pı
a k ia

L e u ko p ı
a k ia is a p o te n tia lly m a lig n ant le s io n d e fin e d as a
"
w h ite p la q u e o f q u e s tio n a b le
ıis k h a v in g e x c lu ded (o th e r ) k n o w n d is e a s e s o r d is o r d e r s th a t c a r r y n o in c r e a s e d r is k fo r can cer
"

(e g ti ic tio n a l ke r a to s e s ) L e u k o p la k ia is ı
in ic a l te r m
,
a c o n ly ; its d e fin itio n is u su a lly m o d ifie d
a tte h is [o p a th o lo g ic
r a e v a lu a tio n Fo ľ e x am pı
e ,
a c lin ic a ıim p r e s s io n o f le u k o p la k ia a t b io p s y
e x a m in a tio n m ig h t s h o w can d id ia s is b ite k e r a to s is
,
,
o r ic h e n p ı
ı an u s

C L IN ı
C A I Iı
N D IN G S

C ı
in ic a lly ı
e u k o p la k ia
, s a ıe d iv id e d in to h o m o ge n o d ho m
u s an n o n o ge n e o u s le s io n s T he
rr o
n o ı
ge n eo u s ty p e is u s t ia ll a th i
y n fı
a t an d u n ifo rı
n h ite p la q u ith ı
, , w e w at e a st I a r e a th a t is
w e ll d e m a i.c a te d ith ith o
w o r w u t fis s u ıin N ho ı
g o n m o ge n e o u s eu ko pı
a k ia is c h a r a c te r iz e d b y
th e p ıe s e n c e o f s p e c k le d o ľ e r y th r o
p la k ic a n d n o du ı
ar o r v e r r u c o u s a re a s E r y th r o ı
e u ko pı
a k ia
c an be m is d ia g n o se d O L P be c a u
as se o f its w h ite d d H
an re co m po n en ts o w e v e r, o th e r c lin ic a l
ig n
s s c a n g id e th e
u c lin ic ia n to th e c o t d ia g n o s is : e r y th r o ı
rre c e u k o p la k ia d o e s n o t
p o s s e s s th e
ty p ic a l w h ite tic u la r c
re ha n ge s an d it is lly ila te r a ıw ith
u su a u n a s s o c ia te d w e lld e m a r c a te d w h ite
p la q L ıe s A re a s o f fi, m in d u r a t io n a lw
n e ss o ľ a ys sho u ld b e b m itte d fo b io p s y
su r ex am in a t io n
P r o ife
ı ra t iv e ı
e u ko pı
v e rr u c o u s a k ia (P V L ) is co n s id e r e d a tb rm o f n o n ho m o ge n eo u s
le u k o p la k ia b y th e W H O It is m o re c o m m o n in w o m en
,
w ith fe w e r th a n 4 5% o f c a se s b e in g
a s s o c ia te d w ith to ba c c h a b it P V L is
a o u su a lly m u ltifo ca l o r a ffe c ts c o n tig u o u s a re a s a n d is
c ha 1 1 c te r iz e d by r e le n tle s s s s io n d
p ro g re an s p re a d ,
w ith th e g in g iv a b e in g th e m o st fr e q u e n tlY
a ffe c te d s ite M o st c a se s f PV L ho
o a re n o n m o ge n eou s w ith a v e rru c o u s o r no d u la r o r

e r y th r o le u k o p la k ia lik e S itLì ila r to

a p p e a ra n c e e r y th t o le u k o p la k ia th e ,
e r y th r o le u k o p la k ia fo rm o F
PV L ca n be m is d ia g n o se d as lic h e n p la n u s be c a u se it is m u ltifo ca l a n d b ila te r a l M ltip le b io p s y
u

ex am in a tio n s s ho w n o ev id e n ce o f c y to lo g ic d y s p la s ia b u t o fte n e x h ib it v e rru c o u s h y p e r p la s ia ,

h y p e r k e r a to s is p a ra k e r a to s is ith
,
o l w e p ith e lia l a tľ o p hy o r K U S T h e re a re m an y d ifte re n c e s

b e tw een lo ca liz e d le u k o p la k ia s (b y ta r th e m o re co m m o n ) an d PV L B e c a u se o t th e s e

d iffe ] e n ces it ig h t b e fu l to c o n s id e r PV L e n tity r a th e r th a n to f

m m o re u se a se p a r a te a rm o

n o n ho m o ge n eo u s le u k o p la k ia

D IA G N O S IS

T h e d ia g n o s is o f tr u e le u k o p la k ia is b a s e d o n a co m b in a tio n o f th e p a tie n t h is to r y c lin ic a l

c o n s id e r a tio n s a n d h is to p a th o lo g y an d is ty p ic a lly a d ia g n o s is o f e x c lu s io n L e u k o p la k ia u su a lly

,

has, at le a s t in p a r t, s h a r p ly de m a ıc a te d m a r g in s , o lle n w ith fis s u r in g ,

an d it is g e n e r a lly

d is lin g u is h a b le fr o m r e a c tiv e k e r a to se s, w h ic h a ie u su a lly po o ľ ly de m a r c a te d le s io ns

E r y th r o le u k o p la k ia te n d s to b e le s s w e ll d e m a r c a te d B io p s y an d h is to p a th o lo g ic ex am in a tio n s

re m a in th e g o ld s ta n d a r d Io r d ia g n o s is a n d a re im p o r ta n t in h e lp in g to e x c lu de o th e r k e r a to tic

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 le s io n s, a s d is c u s se d e a r lie r M an a gem en t de pe n ds o n th e h is to p a th o ı
o g ic d ia g n o s is an d c lin ic a l

p re s e n ta tio n (s e e M an a ge n e n t s e c tio n
ı )
ııIS 丁0 p 八 丁ı10 しO G Y

A b io p s y e x a m in a tio n o ro ra l le u k o p la k ia c a n sho w ı) h y p e r k e r a to s is o r p a r a k e ra to s is w ith

d y s p la s ia c a r c in o ı
n a in s itu ,
o r in v a s iv e c a rc in o m a o r 2) "
b e n ig n hy p e rke r a to s is
"
w ith o u t

d ysp ı
a s ia b u t ith a c a n th o s is
w
,
a tr o phy ,
o r in tla m m a tio n (ie K U S ) F r ic tio
,
n a ık e r a to se s sho u ld

n e v e r b e in c lu d e d in th e c a te g o ry o f le u k o p la k ia o n c e th e d ia g n o s is is e s ta b lis h e d b y b io p s y
e x am in a tio n W h e n d y s p la s ia o r c a r c in o m a in s itu is co n s id e r e d th e m a ı
ig n a n t tr a n s fo r m a tio n
,

r a te is 5 to 36% w ith h ig h e r ıa te s in in d iv id u a ls w ho a re b e te l ]e a F c h e w e rs

C A N C E R R IS K

T he r is k o t m a lig n a n t tr a n s fo r m a tio n fo r o ra l ı
e u ko p ı
a k ia c le r is k fa c to r s d
pe n d s o n a n

h is to p a th o lo g ic d in ic a ı c h a r a c te r is t ic
ı In ı th e r is k fa fo dev
a n c s ge n e ra ,
c to r s r e ı
o p in g o ra ı
le u ko p ı
a k ia a r e s im ila r to th o s e r e p o r te d fo lca d in c lu d e to b a c c o k in g
r o ra n c e r an sm o (e s p e c ia lly
fo lo liz e d le u k o p la k ia s ) h e a v y lc o h o l c o
r ca
,
a n su m p tio n ,
a re c a n u t u s e ,
u ltr a v io le t lig h t e x po s u re

fo r lip le s io n s ,
a n d o ld a ge

H o w e v e r, o th e r fa c to r s , s u c h a s p r o lo n g e d im m u n o su s s io n h is to r y f d
p p re ,
a o ca n c e r a n a

fa m ily h is to r y o fc a n c e r , a re ju s t a s im p o r ta n t b u t le s s w e ll r e c o g n iz e d

A lth o u gh hu m a n p a p illo n a v
ı ir LIs (H P V ) h a s b e e n n o te d in 2 5 % o f o ra l e p ith e lia l d y s p la s ia s

by po ı
ym e ra s e c h a in r e a c t io n ,
th is is an o v e rs e n s itiv e te s t a n d th is p re v a le n c e is lik e ly an

o v e r e s t im a l io n o r c o u ld re p re se n t H PV u n a sso c ia te d w it h c a rc in o ge n e s is 88 H P V a s s o c ia te d o ra l

d y s p la s ia is a sp e c ific an d u n c o m m o n h is to p a th o lo g ic fo rn i o f o ra l e p ith e ļ ia l d y s p la s ia th a t

le u k o p la k ia a iì d is a s s o c ia te d ith h ig h r is k H PV in 10 0 % f c a se s u s in g m o re
p r e s e n ts as w o

sp e c ific in s itu h y b ľ id iz a t io n s tu d ie s a n d m a ig n
ı a n t tr a n s fo r m a tio n o c c u rs in 1 0 % o f c a se s

A D J U N C T IV E S C R E E N IN G A ID S

A d ju n c tiv e s c re e n in g a id s in c lu de 1) v ita l s ta in in g w u id in
ith to ı e b lu e , 2 ) b r u s h b io p s y

e x am in a tio n 3 ) d e v ic e s b a s e d o n a u to fı
u o re s c e n ce 4 ) d e v ic e s b a s e d o n c h e m ilu m in e s c e n ce ,
an d
, ,

liv fo lia te d lls ) A lth o g h th e v is u a liz a tio n

5 ) b io m a rke r a sse s s m e n t (fr o m sa a ,
se ru m ,
o r ex c e u

ls fb r lin ic ia n d th e ir tility r e m a in s c o n tľ o v e r s ia l
d iu p o r ta b le to to u se
a n c ı a re o c s an e a sy u
ș ,

p r im a r ily be c a u se o f h ig h se n s itiv ity b u t lo w spe c ific ity

M A N A G EM EN T

W h ite le s io ith h is to p a th o lo g ic d ia g n o s is o f d y s p la s ia o r c a r c in o m a in s itu sho u ld b e

n s w a

i i fin o d e ra te p ith e lia l d y s p la s ia O f

e x c se d w ith c le a r m a r g n s , e s p e c ia lly fo r c a se s o o r s e v e re e

n o te ,
so m e c a se s o f d y s p la s ia (p a r tic u la r ly m ild d y s p la s ia ) h a v e b e e n re p o r te d to re g re s s ov er

tim e H o w e v e r , it h a s b e e n s h o w n th a t s e v e r a l c a se s o f m ild d y s p la s ia in re a lity co u ld re p re s e n t

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re a c tiv e e p ith e lia l a ty p ia fr o m tr a u m a an d th e r e fo r e re g r e s s io n an d re c u rr e n c e w o u ld be

e x p e c te d

W h ite le s io n s w ith a h is to p a th o lo g ic d ia g n o s is o f "

h y p e r k e r a to s is w ith n o d y s p la s ia "
o r

K U S s ho u ld b e re a s s e s s e d c lin ic a lly to r u le o u t a fr ic tio n a l k e r a to s is a n d to e v a u a te fo

ı r th e

fe a s ib ility o f c o m p le te re m o v a l F o c a l le s io n s w ith po o r ly de m a r c a te d m a r g in s a re lik e ly

ti ic t io n a land m ig h t re q u iıe a y e a r ly l l o w Lıp w ith a b io p s y ex an in at io n o n ly ií p ro g r e s s iv e if

n o d u la r o r v e iT u c o u s o r r e d a re a s d e v e lo p ,
o r if th e r e is e v id e n c e o f in d u ra tio n H o w e v e r, ií th e re

is n o c lin ic a l e v id e n c e o f o b v io u s p a th o g e n e s is a n d th e le s io n ha s s h a rp ly d e m a r c a te dm a r g in s ,

th is s h o u ld b e fo llo w e d c a re fu lly , p e r io d ic a lly r e in v e s tig a te d b y b io p s y e x am in a t io n ,

o r e x c is e d

o r a bı
a te d d e p e n d in g o n th e c lin ic a l c o n te x t L e s io n s la ıg e r th a n 200 m m 2 s ho u ld b e re

e v a lu a te d e v e ry 3m o n th s a n d re e v a lu a te d b y b io p s y e x am in a tio n e v e ry 6 to 12 m o n th s ; p a tie n ts

w ith le s io n s sm a lle r th a n 2 0 0 m m 2 s h o u ld b e fo llo w e d u p e v e ry 3 m o n th s w ith p e r io d ic b io p s y

e x a m in a tio n s d e p e n d in g o n th e c ir c u m s ta n c e s

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 ił* TR

LE U K O P LA K ı
A

Bı
O PSY

LL
E x c iıe

nx l te d

Į :
1 v o rr u c o u s o r

n o d u la r a r e a s
F o lı
o w u E x c is e /a b ı
p a te
e v e ry 3 (n a r ro w
m o n th s ; r e
m a r g in s )
b io p s y e v e r Fo ı
y ıo w u p
12 m o n th s e v e ry 3 m o n th s

e
3-6 m o n th s

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