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Your answers

1. Is chronic hyperplastic candidiasis an oral potentially malignant disorder?

Your answer: [7]
Correct answer: No

Chronic hyperplastic candidiasis is no longer considered an oral potentially malignant disorder(OPMD) based on a consensus report published in 2020 due to lack of evidence, these lesions are often found in heavy smokers and therefore clinical monitoring is recommended similar to that of OPMDs.

2. The majority of oral potentially malignant disorders affect which age group?

Your answer: [8]
Correct answer: The middle aged and elderly

Oral potentially malignant disorders typically affect the middle aged and the elderly, conditions such as oral lichen planus typically present in this age group.

3. Which oral potentially malignant disorder is associated with the highest malignant transformation rate?

Your answer:[9]
Correct answer: Oral erythroplakia

There have been various systematic reviews and meta-analysis on the malignant transformation rate of each of the oral potentially malignant disorders mentioned. Oral Erythroplakia and Proliferative Verrucous Leukoplakia have the highest of Malignant rate transformation.

4. Which clinical phenotype of oral lichen planus is identifiable in the photograph?

Your answer: [14]
Correct answer: Erosive

Atypical lichen planus is not a clinical subtype. Reticular, erosive, atrophic, plaque-like and bullous are recognised clinical subtypes. In this photograph we can see a superficial erosion/ulcer with background erythema in the retromolar area. Anteriorly, we can see white striae with a more reticular pattern.

5. Lichen planus can affect the skin and genitals?

Your answer: [15]
Correct answer: True

Cutaneous lichen planus appears as purple pruritic lesions with a round to irregular shape, some may have grey to white streaks called Wickham’s Striae. These sometimes leave an area of hyperpigmentation that slowly fades. Vulval lichen planus can present with erosions, ulceration and sometimes white lacy streaks. Penile lichen planus usually presents with classical papules in a ring around the glans.

6. The photograph shows a patient with a background of actinic cheilitis who presented with an 8 week history of a persistent ulcer that is hard to palpation. What would be your management approach?

Your answer: [72]
Correct answer: Request urgent incisional biopsy of the ulcerated area to rule out further malignancy

The photograph below shows actinic cheilitis. There are generalised actinic changes on the lower vermillion border with an erosive area approaching the right commissural region. In light of the persistence of the ulcer and induration, an urgent biopsy is essential to rule out further malignancy.

7. What is the main causative agent of actinic cheilitis?

Your answer: [21]
Correct answer: UV radiation

UV radiation is the main aetiological agent in actinic cheilitis. Smoking and alcohol are implicated in oral cavity cancer.

8. Which of the treatment modalities listed below may be used in the management of actinic cheilitis?

Your answer: [22]
Correct answer: Surgery (Vermilionectomy) and Non-surgical therapies including topical fluorouracil (5-FU)

Surgery remains a mainstay in the treatment of actinic cheilitis, topical cytotoxic chemotherapeutics such as fluorouracil (5-FU) can also be used.

9. Dyskeratosis congenita is associated with:

Your answer: [26]
Correct answer: All

Dyskeratosis congenita has many systemic associations. Please consult the e-learning module for further information.

A 45 year old man attends for a review reporting a white area on the right side of the tongue for many years. He is a smoker and consumes 50 units of alcohol per week. He tells you for the last 2 weeks he has been developed some pain on from the right side of the tongue and the area feels ‘firm’.

Figure 1: Homogenous Leukoplakia of the mid right lateral tongue

10. What would be your management approach?

Your answer: [27]
Correct answer: Smoking and alcohol cessation advise and organise an incisional biopsy to rule out dysplasia/malignancy

Smoking and high alcohol consumption increase the risk of oral malignancy. This photograph shows a dense, well circumscribed slightly verrucous white patch. Induration is a red flag and may warrant biopsy to rule out malignancy.

11. The photo shows a patient with oral graft versus host disease (GvHD). Oral GvHD sometimes present with lesions similar to oral lichen planus?

Figure 1. Ulcerative lesion involving the buccal mucosa in a patient with cGVHD

Your answer: [46]
Correct answer: True

Oral GvHD tends to present with features very similar to oral lichen planus (white striations, erythematous areas and ulceration).

12. The main causative agent in oral submucous fibrosis is:

Your answer: [49]
Correct answer: Areca/Betel nut chewing

The main aetiological agent in oral submucous fibrosis is Areca/Betal nut. Smoking and alcohol habits may increase malignant transformation risk.

13. Palatal lesions in reverse smokers are seen most frequently:

Your answer: [53]
Correct answer: In Southeast Asia

Reverse smoking is a rare habit that is practiced in Southeast Asia, typically in south eastern India. The habit involves holding the lit end of the cigarette intraorally.

14. What is the most likely diagnosis for the white patch demonstrated in the photograph below?

Your answer: [54]
Correct answer: Proliferative verrucous leukoplakia

The photograph shows a large verrucous white patch encompassing the gingiva of the lower anterior teeth. There are no erythematous elements or other clinical features pointing to oral erythroplakia or oral submucous fibrosis. The lesion can be differentiated clinically from oral leukoplakia based on the verrucous (wart-like appearance).

15. The most common intraoral site involved in Pproliferative verrucous leukoplakia:

Your answer: [58]
Correct answer: Ginfiva

Proliferative verrucous leukoplakia typically affects the gingiva and less commonly the buccal mucosa/tongue, rarely is the oropharynx involved.

16. What the most common treatment modality for proliferative verrucous leukoplakia?

Your answer: [59]
Correct answer: Dependant on clinical presentation and the presence of other risk factors

Treatment will be dependent on the clinical presentation and the presence of other risk factors, such as a pre-existing OPMD (e.g. oral lichen planus). It may include surgical excision, however, all will require long term monitoring.

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