MALIGNANT TUMOR

1. BASAL CELL Etiology: Clinical features: Histological features:

 Sunlight  4th decade or later ● Appearance of nests, islands or sheets of
CARCINOMA
 Skin pigmentation  M>F cells showing indistinct cell membranes
- “basal cell
epithelioma”  Begins as a small, slightly with large, deeply staining nuclei and
- “Rodent Ulcer” elevated papule which variable numbers of mitotic figures.
ulcerates, heals over then
- Develops frequently
breaks down again. ● Basal cell –pluripotential cell
on the exposed
surfaces of the skin
● It enlarges, but still evidences
(face/ scalp)
periods of attempted healing.
- Men (blonde with fair o Adenoid basal cell carcinoma –mimics
complexion)
● Crusting ulcer (superficial) glandular formation
- Benign carcinoma
develops a smooth rolled
border (tumor cells –spreads o Cystic basal cell carcinoma –presence
laterally) of many cyst in the lesion
Treatment and prognosis:
● Untreated lesions continue to o Keratotic basal cell carcinoma –
 Surgical excision or
enlarge, infiltrate adjacent and formation of parakeratotic cells and horn
xray radiation
deeper tissues and may erode cyst and hair
deeply into cartilage or bone.
o Solid or primordial basal cell
● Middle 3rd of the face carcinoma –cells have little tendency to
differentiate
● Does not arise from the oral
mucosa

2. SQUAMOUS Etiology: Etiology: Histologic Features

 Environmental etiologic 4 herpes virus that are known to ● Moderately well-differentiated
CELL
factors: cause human disease: neoplasms with some evidence of
CARCINOMA o Tobacco  Epstein-Barr Virus (EBV) – keratinization
- “Epidermoid infectious mononucleosis ● Cancer staging
Carcinoma” o Alcohol  Cytomegalovirus (CMV) –
- Most common cytomegalic inclusion disease
malignant neoplasm o Syphilis  Herpes simplex virus (HSV)
of the oral cavity –herpes simplex infection in
o Nutritional various clinical forms
deficiencies  Varicella-zoster virus –
chicken pox, herpes zoster or
o Sunlight shingles

o Miscellaneous  Has malignant implications:

factors  EBV –the African jaw
(heat, trauma, (Burkitt’s) lymphoma and
sepsis and irritation nasopharyngeal carcinoma
from sharp teeth  CMV –Kaposi’s sarcoma
and dentures)  HSV –carcinoma of the uterine
cervix
o Virus
1. Carcinoma of the lip  men; lower lip; 62yo
1. Tobacco
2. Syphilis
3. Sunlight
4. Poor oral hygiene
5. Leukoplakia
 Usually begins in the vermillion border
 Small area of thickening, induration and ulceration or irregularity of the surface
 Crater-like defect
 Well-differentiated (grade 1 carcinoma)
 Surgical excision or xray radiation

2. Carcinoma of the tongue  W < M (except in Scandinavian countries –Plummer Vinson syndrome)
1. Syphilis;
2. leukoplakia;
3. poor oral hygiene;
4. chronic trauma;
5.use of alcohol and tobacco
 Painless mass or ulcer –painful (infected)
 Superficially indurated ulcer with slightly raised borders –fungating, exophytic mass or
infiltrating the deep layers of the tongue
 Metastasis occurs (cervical)
 Combination of surgical excision xray radiation

3. carcinoma of the floor of the  Men

mouth 1. Smoking and
2. leukoplakia (epithelial dysplasia and malignancy)
 An indurated ulcer of varying size on one side of the midline
 May or may not be painful
 Anterior part (extensions –lingual mucosa, mandible, tongue)
 May invade the deeper tissues (submandibular and sublingual glands
 Metastasis –submaxillary lymph nodes and contralateral
 Tx –difficult and unsuccessful (radiation)

4. Carcinoma of the Buccal  M 10:1

Mucosa 1. Tobacco and
2. betel nut chewing;
3. leukoplakia;
4. chronic trauma; 
 Develop most frequently along or below to a line opposite the plane of occlusion
 Exophytic or verrucuous growth
 Painful, ulcerative; induration and infiltration
 Surgical excision or radiation

1. Syphilis,
5. Carcinoma of the Gingiva
2. chronic irritation,
3. tooth extraction
 Mandibular gingiva (edentulous; fixed gingiva)
 Areas of ulceration which may be poorly erosive lesion or exhibit an exophytic, granular,
verrucous type
 Invasion –sinus, palate, tonsillar pillar (maxilla)
 Floor, cheek, deep into the bone (mandible)
 Pathologic fracture (latter)
 Metastasis –submaxillary or cervical nodes
 Surgery

6. Carcinoma of the Palate  Poorly defined, ulcerated, painful lesion on one side of the midline
 Frequently crosses the midline, laterally (lingual gingiva) posteriorly (tonsillar pillar, uvula)
 Tumor of the hard palate –invade the bone, nasal cavity
 Soft palate -nasopharynx

 Epidermoid carcinoma –ulcerated lesion

 Tumors of accessory salivary gland origin –not ulcerated and covered with an intact mucosa
  Surgery and x-ray radiation

7. Carcinoma of the Maxillary  Hopelessly advanced before diagnosis

Sinus  Swelling or bulging of the maxillary alveolar ridge, palate or mucobuccal fold, loosening or
elongation of the maxillary molars or swelling of the face inferior and lateral to the eye
 Unilateral nasal stiffness, or discharge
 Actual spread of the tumor reflect on the clinical manifestations

3. MALIGNANT MELANOMA Oral Manifestations Treatment and Prognosis

 Neoplasm of epidermal melanocytes
 One of the more biologically
unpredictable and deadly of all human
neoplasms
 3 most common cancer of the skin
rd
(basal and squamous cell carcinoma)  size
2 phases of growth:
 Radial-growth phase –confined in the
epidermis
 Vertical growth phase –increased
virulence of the neoplastic cells; a
decreased host cell response
NOTE:  cell, macrophages and
Initial phase of growth –neoplastic cells are shed
with normally maturing cells (some penetrate the
basement membrane) –destroyed by a host cell
immunologic response
vertical –begins when neoplastic cells populate
the underlying dermis (metastasis is possible)
Types of cutaneous melanoma:
 Superficial spreading melanoma –most
common in Caucasians; rapid-growth
phase (premalignant melanosis or
pagetoid melanoma in situ); tan, brown-
black or admixed lesion (back, head and
neck, chest and abdomen, extremities)
 Nodular melanoma –vertical growth
phase; a sharply delineated nodule with
degrees of pigmentation; pink
(amelanotic melanoma) or black; back,
head and neck
 Lentigo maligna melanoma –radial
growth phase (lentigo maligna or
melanotic freckle of Hutchinson)
 Palate and maxillary gingiva/alveolar
ridge  Cutaneous malignant
 A deeply pigmented area, at times melanoma –surgical
ulcerated and hemorrhagic, which excision
tends to increase progressively in - BANS –has a tendency
to metastasize
- Chemotherapy,
immunotherapy and
radiation therapy
 Oral melanoma –surgical
Histologic Features excision, jaw resection,
 Superficial spreading melanoma lymph node dissection
- Rapid-growth phase –presence of
large, epithelioid melanocytes
distributed in a pagetoid manner NOTE: BANS –back, arm, neck
and skull (0.75mm in thickness)
(epithelium)
 Melanocytes infiltrate the
basement membrane –host
melanophages
- Vertical-growth phase –proliferation of
malignant epithelioid melanocytes in
the underlying connective tissue 
 Nodular melanoma –characterized by
large, epithelioid melanocytes within the
CT with small ovoid and spindle-shaped
cells
- Melanin may be present
- The tumor cells may invade and
ulcerate the overlying epithelium and
penetrate the deep soft tissues
 Lentigo maligna (Melanotic freckle of
Hutchinson) –increased numbers of
atypical melanocytes within the basal
epithelial layer
- Invasive spindle cells in the underlying
dermis
- Lymphohistiocytic infiltrate is present