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Verrucal-Papillary Lesions (Ch 15) - Coggle Diagram

- - - - Regions can occur on any mucosal surface in anogenital area; clinically appear as multiple flat, pinkish, exophytic growths with sessile basis and rough caulilower like surfacesLesions me more frequently occur on labial and lingual frenulum and soft palate and oral pharynx; lesions begin as papulary growths that enlarge and coalesce, becoming nodular, pink, exophytic growth with a rough papillary surface
    - - Diagnosis and treatment helps prevent transmission; infection is more common in immunosuppressed
    - - Transmitted by direct contact (oral-oral/oral-genital)
    - - Oral lesions are usually surgically removed; recurrences are common; HPV 16 and 18 exposure has increased risk of developing anogenital carcinomas
    - - Approximately 30 different types of HPV can infect the anogenital tract; HPV subtypes 6 and 11 are the most common causes. Subtypes 16 and 18 are less commonly associated
  - - - Manifest as painless, exophytic, well circumscribed, pedunculated, or sessile masses; may have cauliflower-like surface texture; may consist of many finger- or hair-like projections; range in color from white to pink; found on lips or any mucosal surface; seen most often on soft palate; Distinguishing characteristics are cauliflower like appearance suggesting infection with HPV
    - - Lesion should be removed because of association with some forms of HPV with oral malignancies; patient may be able to transmit causal viral agent to others
    - - Direct contact between virus and non-intact mucosa; autoinoculation
    - - Conservative surgical excision, cryotherapy, electrodesiccation; recurrence is low unless immunosuppressed
    - - HPVs 2, 6, 11, and 57 have been associated with benign or squamous papillomas; 6 and 11 are identified most commonly
  - - - Pink to whitish somewhat translucent, surface that is only slightly cauliflower-like; soft on palpation; generally less keratin than other HPV-related lesions; common areas are lips, tongue, buccal mucosa; lesions more generalized within oral cavity than other forms of HPV
    - - None
    - - Similar to that of other HPV's, by surface contact with the virus through a break up any mucus or barrier; usually do to localize trauma
    - - Treatment is not always necessary; lesions often resolve spontaneously
    - - HPV's 13 and 32 have been implicated
- - - - Appears on the pallet or mucosa as a field of pink to bright red, clustered papules that are firm to palpation; almost always related to the presence of dentures or oral appliances
    - - Patient should be treated with a soft denture reline material prior to surgical removal of the lesion and fabrication of a new denture; education on the proper use and care of dentures including the fact that dentures must be removed from the mouth for a period of time every day is important
    - - Not applicable
    - - Lesion should not be removed without the fabrication of a new denture, since mechanical trauma related to poor fitting denture will only happen again; papillary hyperplasia is frequently associated with candidiasis, indicating that both the tissue and denture need to be treated with an antifungal; prognosis is excellent as long as new dentures are made and patient is educated
    - - Reactive tissue proliferation due to mild, persistent trauma caused almost exclusively by the rubbing of an ill-fitting dentures on the mucosa during function
- - - - Most KA's appear on son exposed skin of face, neck, and upper extremity's; dumb shaped nodules with a smooth shiny surface, sensual crater and a cord or plug of keratin; rarely seen before 45; usually appear on vermilion border of lower lip; not found on mucous membranes within the oral cavity
    - - Medical referral is warranted; patients who develop KA's are at higher risk for nonmelanoma skin cancer
    - - Not applicable
    - - Surgical excision is the treatment of choice; may best be treated similar to SCC; prognosis is excellent with complete removal
    - - Exact cause is unknown and controversial; regarded by some as benign and by others as a low-grade tumor variant of invasive SCC; associations exist with sunlight, chromosomal abnormalities in the skin, occupational exposure to tour and or pitch, a compromised immune status, and exposure to several forms of HPV including types nine, 11, 13, 16, 18, 24, 25, 33, 37, and 57
  - - - Lesion may be hidden in the crypts of the tonsils; clinically will show obvious inflammatory tissue with the papillary appearance; usually cervical node and mandibular lymph node involvement, lesion in the throat or oral tissues that bleeds easily and does not heal, or a persistent patch, red or white, a lump or thickening, or a neck mass; difficulty in moving the tongue and chewing our notable indications
    - - Tooth pain, ear pain, and difficulty eating or swallowing may be reported. Attention during EO when palpating the cervical and mandibular lymph nodes is crucial
    - - Not applicable
    - - Prognosis is better for those with oral cancer and HPV positive over HPV negative
    - - Sixth leading type of cancer worldwide; link to sexual practices and HPV 16; majority are found on lateral borders of the tongue and the base of the tongue; floor of the mouth is also a prime area due to increased blood supply
  - - - Appear as white patches or cauliflower like papillary, exophytic spreads; maybe fissuring and ulceration; usually found on vestibular mucosa, alveolar ridge, gingiva, and buccal mucosa general appearance coupled with a history of spit tobacco is highly suggestive
    - - Often forms with long standing leukoplakia associated with fit tobacco should make efforts to educate patientGeneral appearance coupled with a history of spit tobacco is highly suggestive
    - - Not thought to be contagious although HPV has been localized within these lesions
    - - Surgical removal is ideal; most have a good prognosis
    - - Appear to be related to the use of spit tobacco, either snuff or chewing tobacco; smokeless tobacco is a major source of cancer causing nitrosamines; mucous membrane exposure to alcohol appears to be a factor