Lesiones de cavidad oral 2

Candidiasis and Oral Lesions

Overview of Candidiasis

• The presentation discusses various white lesions in the mouth, specifically identifying them as candidiasis infections.

• Different forms of oral candidiasis are highlighted, including a white plaque that can be easily detached and an erythematous form characterized by satellite lesions.

Clinical Features

• The left photo shows cottony white lesions confined to the buccal mucosa, while red lesions on the soft palate indicate more severe infection.

• Common species affecting the mouth include Candida albicans, with risk factors such as smoking, foreign bodies, radiation exposure, and corticosteroid use.

Symptoms and Diagnosis

• Patients typically report burning sensations or discomfort; some may be asymptomatic. In immunocompromised individuals, it can present as ulcers.

• Biopsies are crucial for diagnosis when lesions persist beyond two weeks despite treatment.

Differential Diagnosis of Oral Lesions

Distinguishing Candidiasis from Other Conditions

• Differential diagnoses include erythroplakia (red lesion without clear cause) and lichen planus which presents differently.

• Diagnosis involves scraping the lesion for KOH preparation or culture to confirm candidiasis.

Treatment Options

• Treatment can be topical or systemic; severe cases often require systemic antifungals like azoles.

Ulcerated Lesions: Pemphigus Vulgaris

Characteristics of Pemphigus Vulgaris

• Ulcers in the mouth may indicate pemphigus vulgaris, an autoimmune condition leading to blistering due to antibodies against cell adhesion molecules.

Clinical Signs

• A key clinical sign is Nikolsky's sign; rubbing a lesion causes it to detach. This indicates epithelial involvement typical of pemphigus vulgaris.

Herpes Simplex Virus Lesions

Presentation of Herpes Simplex Lesions

• Herpes simplex presents with small vesicular lesions following nerve pathways in the oral cavity. Initially appearing as vesicles before ulceration occurs.

Progression and Symptoms

Oral Lesions and Their Characteristics

Common Oral Lesions

• The lesions affecting Rosalía's lip are very painful and represent a common diagnosis. In the oral cavity, multiple lesions can be observed, with bone lesions being prevalent in 60-90% of the population, transmitted through direct contact.

• Another type of lesion is small, painful ulcers that may appear black. These are often confused with other conditions; they are known as recurrent stomatitis characterized by non-traumatic ulcers throughout the oral cavity.

Differentiating Conditions

• Diagnosing these lesions can be challenging since vesicles typically rupture quickly, making them hard to identify. Symptoms may include general malaise or prior herpes infections.

• Aphthous stomatitis affects 20-40% of the population and involves oral mucosa without vesicular phases. Its etiology remains unknown but could be multifactorial, triggered by various factors including stress.

Types of Ulcers

• There are two types of minor aphthous ulcers: Benignol ulcers (minor) and major ulcers. A specific form called "Bar Pretty" can easily be confused with others.

• Stress is a significant trigger for aphthous stomatitis; individuals under high stress often develop these ulcers.

Other Lesion Types

• Another condition discussed is erythema multiforme, which presents confined lesions on the lower lip and can also affect skin areas. It ranges from mild to severe forms like Stevens-Johnson syndrome and toxic epidermal necrolysis.

• Erythema multiforme is an allergic reaction potentially triggered by medications or viral infections, characterized by complex formation leading to vasculitis and ulceration due to keratinocyte necrosis.

Pigmented Lesions

• Pigmented lesions vary widely; recognizing which require biopsy versus those that may have malignant characteristics is crucial.

• The ABCDE method helps evaluate pigmented lesions:

• A: Asymmetry indicates higher malignancy risk.

• B: Border definition matters—poorly defined borders raise suspicion.

• C: Color variation suggests malignancy.

• D: Diameter over one centimeter or five millimeters warrants concern.

• E: Elevation or rapid evolution also signals potential malignancy.

Clinical Observations

• An example includes observing a hyperpigmented lesion in the buccal mucosa that appears asymmetrical with poorly defined borders and heterogeneous color distribution.

• Despite not being elevated, this lesion's characteristics suggest it could indicate underlying issues related to melanocytes' function in pigmentation processes.

Biopsy Considerations

• When considering biopsies for suspected malignant lesions, it's essential to assess their organization at a cellular level—disorganized patterns may indicate malignancy risks.

Melanoma and Oral Lesions: Key Insights

Understanding Melanoma in the Oral Cavity

• The discussion begins with the identification of a lesion on the epithelium, referred to as a "tattoo program gamma," indicating potential malignancy. The lesion shows heterogeneous borders and diffuse coloration, suggesting it may be a melanoma.

• Definitive diagnosis requires biopsy; melanoma is notably rare in oral cancers, constituting less than 1% of cases. It predominantly affects Asian and Black patients, with 40% confined to the hard palate.

• Melanomas exhibit two growth phases: horizontal and vertical. Vertical growth indicates invasion beyond the basal layer, with 85% being invasive at diagnosis. This aggressive nature results in only a 40% five-year survival rate.

Risk Factors and Other Lesions

• Smoking is highlighted as a significant risk factor for oral lesions due to tobacco-induced pigmentation (melanin deposition). This serves as an attempt by melanocytes to repair damage from tobacco exposure.

• Various types of hyperpigmentation are discussed, including physiological pigmentation in darker skin tones and friction-induced lesions. Patient habits such as biting or flexing can lead to these conditions.

Specific Conditions Related to Hyperpigmentation

• The presentation includes images of specific conditions: Takayasu's disease (telangiectasias), Peutz-Jeghers syndrome (lip pigmentation), and drug-related hyperplasia from phenytoin use.

• Osler-Weber syndrome is mentioned, characterized by numerous telangiectasias affecting nasal areas. The wide spectrum of oral cavity lesions necessitates detailed descriptions and multiple biopsies for accurate diagnosis.

Conclusion on Diagnostic Approaches