Malignant epithelial tumours-2,Verrucous melanoma/dental courses
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Malignant epithelial tumours-2,Verrucous melanoma/dental courses
- 1. Malignant epithelial tumours-2 INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.com
- 2. OBJECTIVES At the end of the lecture student should be able to – Enlist differences between sqamous cell carcinoma & verrucous carcinoma –Describe clinical features, histopathological features & treatment of verrucous carcinoma – Describe types,clinical features, histopathological features & treatment of malignant melanoma www.indiandentalacademy.com
- 3. Verrucous carcinoma Snuff dipper’s cancer, Ackerman’s tumor • Low grade variant of OSCC • Ackerman in 1948 reported first case • Occurs in larynx, esophagus, nasal fossae, external auditory meatus, lacrimal duct, skin, scrotum, penis, vulva, vagina, uterine cervix, perineum, leg and odontogenic cyst lining www.indiandentalacademy.com
- 4. Differences of OSCC & Verrucous carcinoma OSCC 1. Fast growing 2. Usually ulcerated 3. Invasive 4. High metastasis 5. Radical treatment 6. Prognosis poor Verrucous carcinoma 1. Slow growing 2. Exophytic growth 3. Superficial invasive 4. Low metastatic potential 5. Simple local excision 6. Good prognosis www.indiandentalacademy.com
- 5. Clinical features • Elderly patients 60-70 years • Buccal mucosa, gingiva, alveolar ridge, palate, floor of mouth • Exophytic, Papillary, pebbly surface covered by leukoplakic film www.indiandentalacademy.com
- 6. Regional lymph nodes tender & enlarged Pain, difficulty in mastication Tobacco/ areca nut chewing, ill fitting dentures www.indiandentalacademy.com
- 7. Histologic features • Marked epithelial proliferation • Downgrowth of epithelium without true invasion • Well differentiated epithelium with little mitotic activity • Cleft like spaces lined by parakeratin • Hallmark is parakeratin plugging • Basement membrane often appears intact • Incase of inflammation focal intraepithelial abscess formation is seen www.indiandentalacademy.com
- 8. Histopathological Features Parakeratin pluggingEpithelial proliferation www.indiandentalacademy.com
- 9. Treatment & Prognosis • Surgery • Radiation • Ionizing radiations may trigger anaplasia • Good prognosis www.indiandentalacademy.com
- 10. Malignant melanoma • Neoplasm of epidermal melanocytes • May develop in preexisting nevi • Skin melanomas common • Oral melanomas rare but more aggressive • 25% occur in head & neck region • 40% on extremities • Rest on trunk www.indiandentalacademy.com
- 11. Clark Concept Radial growth phase • Initial growth phase • Lasts for many years • Confined to epidermis • Normal shedding of neoplastic cells • Penetrating cells destroyed by immune response Vertical growth phase • Neoplastic cells populate dermis • Increased virulence of neoplastic cells • Decreased immune response • Metastasis possible www.indiandentalacademy.com
- 12. Classification • Superficial spreading melanoma • Nodular melanoma- vertical growth phase • Lentigo maligna melanoma www.indiandentalacademy.com
- 13. ABCD features of Malignant melanoma • A- Asymmetry • B- Border irregularity • C- Color Variegation • D- Diameter greater than 6 mm www.indiandentalacademy.com
- 14. Superficial spreading melanomas • Most common cutaneous melanoma in caucasians • Radial growth phase is known as Premalignant melanosis/ Pagetoid melanoma in situ • Tan, Brown, Black or admixed www.indiandentalacademy.com
- 15. Sun exposed skin, especially back, head & neck, chest, abdomen Radial growth phase lasts for several months to years Vertical growth phase characterized by increase in size, change in color, nodularity, ulceration www.indiandentalacademy.com
- 16. Nodular melanoma • 13% of cutaneous melanoma • No or short radial growth phase • Sharp delineated nodule with pigmentation • May be pink (amelanotic melanoma), black • Occur on back, head & neck skin of men www.indiandentalacademy.com
- 17. Lentigo maligna melanoma • 10% of melanomas • Radial growth phase is known as lentigo maligna or melanotic freckle of Hutchinson • Macular lesion on malar skin of middle aged • Common in women www.indiandentalacademy.com
- 19. Oral manifestations • Palate, maxillary gingiva, alveolar ridge, buccal mucosa, lips, floor of the mouth • Deeply pigmented areas • Ulcerated, hemorrhagic area • Oral lesions tend to be aggressive so they have been termed as acral lentigerous melanomawww.indiandentalacademy.com
- 20. Histopathologic features • Presence of large epitheloid melanocytes • Less Common variants are desmoplastic, neurotropic, spindle cell, balloon cell balloon cell • Host cell response depending on type of melanoma www.indiandentalacademy.com
- 21. Treatment & Prognosis • Surgical excision • Poor prognosis www.indiandentalacademy.com
- 22. Summary • Differences between sqamous cell carcinoma & verrucous carcinoma • Clinical features, histopathological features & treatment of verrucous carcinoma • Types,clinical features, histopathological features & treatment of malignant melanoma www.indiandentalacademy.com