Description of Lesions1800 Introduction to Clinical Procedures

Tiffany Baggs, RDH, BASDH

Lesions of all kinds Elevated Lesions Depressed Lesions Flat Soft Tissue Lesions

All lesions: Single or Multiple

Wilkins page 151-156

Elevated Lesions Blisterform: fluid filled, soft and

translucent Vesicle: small 1cm or less, serum or

mucin Pustule: any size, pus, yellowish Bulla: large 1 cm or more, serum or

mucin, blood

Elevated Lesions Nonblisterform: solid lesion, no fluid,

firm Plaque: “pasted on appearance” Papule: small, solid, pointed, rounded or

flat topped, Nodule: larger than a papule greater than

5 mm less than 1 cm Tumor: 2 cm or greater, general swelling

or enlargement

Papules, Nodules, TumorsTake note of the base of lesion Pedunculated: attached to narrow stalk

Sessile: base as wide as lesion

Depressed Lesions Below the level of the skin or mucosa

Ulcer: loss of continuity of the epithelium, gray to yellow, surrounded by red

Erosion: shallow, depressed lesion that does not extend through the epithelium

Regular / Irregular Outline Smooth / Raised Margin Superficial / Deep

Flat Lesions or macule Single macule or Mulitiple macules

Regular / Irregular

Other Descriptions Crust Erythema Exophytic Indurated Papillary Petechiae Pseudomembrane Polyp Punctuate Torus Verrucous

Oral Cancer Any patient Red flag:

Tobacco use Alcohol use Sun exposure

Discovery- the earlier the better Head, Neck, Oral Examination

Every appointment/Document Common site

Floor of the mouth Tongue lateral border Lower lip Soft Palate (gingiva, buccal mucosa, oropharynx)

Self-examination for Patients

Many forms White areas Red Areas Ulcers Masses Pigmentation

Area to be watched, documented If area does not change/heal, what do

we do?

Return in two weeks Biopsy: removal and examinations of a

sections of tissue Cytologic smear: surface cells are

removed Not biopsied- patient refuses biopsy

Referral out for biopsy: dermatologist, oral surgeon

Exfoliative cytology

Oral Cancer Detections Systems Velscope

ViziLite

Velscope http://velscope.com/about_velscope/

Cordless, portable and rechargeable: “ring of light” illumination

healthy cells in the mouth fluoresce= emitting a bright green glow

Unhealthy cells , lack of fluorescence= appearing dark when viewed against the healthy tissue.

ViziLite http://www.zila.com/40/VIZILITE%26REG%3B%20PLUS/

slightly desicates the cells to make the nuclei more prominent, more visible

low intensity light from the handheld light source is reflected off of these abnormal cells down to the basement membrane where the nuclei have been rendered more prominent, and appear to "glow" – making abnormal cells easier to see.

Mouthrinse, dyes Patient rinses with a solution for 1 minute, expectorates, lights

are dimmed or special glasses used, handheld light stick is used

Suspicious areas turn a blue color

Documentation (A,B,C,D,&T) Anatomic location

where is it? Border

demarcated? Regular or irregular? Color change configuration

Color, patter? Diameter/dimension

Irregular, oblong: length x width Circular: diameter

Type Flat Elevated Fluid filled Loss of skin/mucosa

Documentation Have a baseline Note what kind of lesion Follow up appointments- note any

changes For legal purposes be as detailed as

possible.

Teach Patient Self examination Diet, nutritional effects on health Oral health tends to reflect general

health

Warning Signs of Oral Cancer Swelling, lump, or growth – with or without pain White scaly patches Red velvety areas Sores that do not heal in 2 weeks Numbness, tingling Excessive dryness or wetness Hoarseness, sore throat, persistent coughing or

feeling of “lump in the throat” Difficulty swallowing Difficulty in opening the mouth

THE END…………..