wenchen wang 1. white lesions of the oral mucosa 2. solitary oral ulcer and fissures 3. yellow...

WenChen Wang

1. White lesions of the oral mucosa

2. Solitary oral ulcer and fissures

3. Yellow conditions of the oral mucosa

王文岑高雄醫學大學牙醫學系高醫大附設醫院 S 棟 2 樓口腔病理影像診斷科

07-3208284; [email protected]

Differential Diagnosis of Oral and Maxillofacial lesions

WenChen Wang

White lesions of the oral mucosa

Keratotic Lesions 1. Leukoedema

2. Linea alba buccalis3. Leukoplakia4. Nicotinic stomatitis, snuff-dipper’s lesion5. Benign migratory glossitis and mucositis6. Lichen planus7. Papilloma, verrucous vulgaris8. white exophytic squamous cell carcinoma,

Verrucous carcinoma9. Hypertrophic candidiasis10. White sponge nevus

WenChen Wang

Sloughing, pseudomembranous, necrotic lesions

Plaque Traumatic ulcer Pyogenic granuloma Chemical burns ANUG Candidasis

WenChen Wang

Short-term ulcers Traumatic ulcers (most) Recurrent aphthous ulcers (minor) Recurrent intraoral herpes simplex lesi

ons Ulcers as result of odontogenic infectio

n Ulcers with generalized mucositis or ve

siculobullous disease Ulcers secondary to systemic disease

Ulcers

WenChen Wang

Persistent ulcers Traumatic ulcers (occasional) Ulcers from odontogenic infection Squamous cell carcinoma Chancre Gumma Ulcer secondary to systemic disease Low-grade mucoepidermoid tumor Metastatic tumor

WenChen Wang

Normal Color of Oral Mucosa

1). dark pink (reddish) to very pale (almost white).

2). thickness of epithelium, degree of keratinizationA). thicker epithelium: more keratinized, more fibrous and

less vascular subepithelial connective tissue--color is whiter; hard palate, fixed gingival, dorsal surface of the tongue.

B). darker pink or more reddish in color: less keratin, more vascular tissues; vestibule, floor of the mouth, ventral surface of the tongue, retromolar regions.

C). normal variations pigmentations.

D). substances in the blood, i.e. hemoglobin level polycythemia (red, cherry red) anemia (pale).

WenChen Wang

Healthy oral mucosa

WenChen Wang

Leukoedema non-malignant variation of normal

mucosa. most often at buccal mucosa, but also

other sites (labial mucosa, soft palate). most often seen adults > 40 yrs. clinical features:

early stage: firmly opalescence; later stage: definite grayish white cast

with coarsely wrinkle surface which cannot be removed with a tongue blade, but will disappear on stretching.

(if injury: red eroded area, mimic cheek biting).

WenChen Wang

Leukoedema

WenChen Wang

Leukoedema

microscopic findings: increased thickness of epithelium. marked intracellular edema (ballooning) acanthosis: abnormal thickening of the spin

ous layer (may be severe with elongation, thickening, blunting, and confluence of the rete pegs or may consist only of their elongation).

parakeratosis: hyperkeratosis with retention of nuclei.

WenChen Wang

Leukoedema

WenChen Wang

Leukoedema

D.D. leukoplakia, cheek-biting le

sion, white sponge nevus.

Treatment: no treatment is required

WenChen Wang

Linea alba buccalis usually on buccal mucosa near the occlusal pl

ane. usually bilateral, may be related with occlusal t

rauma, therefore more prominent if patient has little overjet of molars and premolars.

Microscopic findings: increased thickness of epithelium, or hyperort

hokeratosis (hyperkeratosis without retention of nuclei).

Treatment: no special treatment, to avoid bite injury, cha

nge the relationship of upper and lower teeth (new denture or orthodontic treatment)

WenChen Wang

Linear alba

WenChen Wang

Leukoplakia White patch keratotic change occurring on mucous

membranes. usually caused by chronic irritation.

important etiologic factors including:

smoking, cold temperature, hot and/or spicy foods, alcohol, betel nut and /or tabacoo chewing, occlusal trauma, sharp edges of prostheses or teeth, actinic radiation.

WenChen Wang

LeukoplakiaClinical features: asymptomatic, old age group (40–70 yrs).most happened at: tongue, floor of the mouth, lower lip, commissures, palate, mucobuccal fold, alveolar ridge, retromolar area, buccal mucosa.

D.D.first R/O lesions of sloughing pseudomembranous types.easy to scrap off or not? if not, lesions are keratotic and need to D.D. with many white lesions.

WenChen Wang

Homogeneous thick leukoplakia

WenChen Wang

Leukoplakia

WenChen Wang

Speckled leukoplakia

WenChen Wang

Non-homogeneous thick leukoplakia

WenChen Wang

Verrucous leukoplakia

WenChen Wang

Hairy leukoplakia Special types of Leukoplakia

Hairy leukoplakia AIDS patient: irregular surface like hair. acanthosis with marked hyperparakeratosis wi

th formation of ridged and keratin projections, areas of ballooning cells and little or no inflammation in the connective tissue.

Ballooning changes = koilocytes: enlarged cells, some with enlarged nuclei with perinuclear halos, others are pyknotic nuclei.

(papilloma-like virus) ,(EM: EB virus), (Immunofluorescence staining for EB virus capsid antigens).

WenChen Wang

EB 病毒感染引起

毛狀白斑(Hairy leukopla

kia)

WenChen Wang

Hairy Leukoplakia on margin of tongue in a homosexual man

WenChen Wang

Koilocytes: Hairy leukoplakia

WenChen Wang

Lesion due to corroded amalgam fillings lingually in mandibular molars, similar with h

airy leukoplakia

WenChen Wang

D.D. of hairy leukoplakia in AIDS

1. lesions due to restorative materials: corroded amalgam fillings, white lesions will disappear within a few weeks after fillings are replaced by plastic material.

2. leukoplakia: a. idiopathic leukoplakia: often locate

d on tongue (inferior surface), usually middle-aged women, extensive and smooth surface.

b. tobacco-associated leukoplakia: border of tongue, well-defined, smooth surface, regress after stop smoking.

WenChen Wang

D.D. of hairy leukoplakia in AIDS

3. lichen planus: border of the tongue, rare (reticular type).

4. chronic hyperplastic candidiasis: labial commissures extending to the buccal mucosa, disappear after fungi-static treatment.

WenChen Wang

White Sponge Nevus

young, usually can be seen before puberty wide spread, usually whole oral cavity has familial pattern

WenChen Wang

D.D with lichen planus

Lichen planus usually involve several lesions, leukoplakia is more often a solitary lesion.

may have Wickham’s striae: fine grayish white lines arranged in a lace-like pattern

may have skin lesion (leukoplakia : no skin lesion)

WenChen Wang

Lichen planus

WenChen Wang

Nicotinic stomatitis or smoker’s palate

Nicotinic stomatitis or smoker’s palate, smoker’s keratosis

man, pipe smokers. usually whole hard palate. reddish stomatitis changed to slightly

opalescent then white. usually “red/pink dots/spots” as the c

enters of lesion indication inflammation of minor salivary glands.

usually disappear after stopping pipe smoking.

WenChen Wang

Stomatitis nicotina palati

WenChen Wang

Snuff dipper’s lesion, Tobacco chewer’s lesion

parboiled appearance of the white lesion, some are thick white plaque

lesion depends on where the tobacco was contact with the mucosa.

usually on the mandibular vestibule (both the incisors and the molar regions).

if change the habit, then most lesions will completely disappear.

WenChen Wang

Tobacco chewer’s lesion

WenChen Wang

Hairy Tongue

WenChen Wang

White hairy tongue

1.elongation of the filiform papillae: increased retention of keratin.

2.male more than female.

3.depends on foods, the color can be different.

4.treated by tongue brushing.

WenChen Wang

Black Hairy Tongue

WenChen Wang

Black hairy tongue Caused by elongated filiform papillae.

Other causes:

(i) antibiotics (penicillin or tetracycline)

(ii) mouthwashes (sodium perborate or

chlorhexidine)

(iii) iron preparations

(iv) smoking

(iv) some foodstuffs

(v) herbs

WenChen Wang

Geographic Tongue

WenChen Wang

Geographic tongue Benign migratory glossitis and mucositis (Ge

ographic tongue) 1.psychological influences and suspected. 2.irregularly shaped red patches and white

patterns like map, on the dorsal , ventral and lateral surfaces of tongue. 3.red patches: desquamated filiform papillae: enlarge and regressive:change every week then completely disappear.

WenChen Wang

Geographic tongue

4.generally asymptomatic, sometimes burning sensation, tenderness and pain.

5. treated with : a. bland diet; b. coating the lesion with triamcinolone in Orabase, if symptoms occur

WenChen Wang

Median rhomboid glossitis

WenChen Wang

Median rhomboid glossitis May be congenital ( persistence of the tuberc

ulum impair) or may be associated with candidal infection. Smoking may predispose to the candidosis.

There is: (i) absence of filiform papillae. (ii) epithelial hyperplasia and acanthosis. (iii) chronic inflammatory infiltrate in the lami

na propria.

WenChen Wang

Lichen planus

1. Affecting 0.5-2.0% of the population

2. Mean age at onset: 30-50 years

3. A mild predilection for females

4. Six forms: reticular, papular, plaque, atrophic, erosive, bullous

5. Malignant transformation -- <1%

6. Etiology: emotional stress or

aberrant cellular immunity

WenChen Wang

Lichen planus

7. sites: mostly at buccal mucosa (85%), others including gingiva, tongue, palate, floor of the mouth, vermillion border, (skin: small flat papules/ulceration may fuse together).

WenChen Wang

Reticular lichen planus (Wickham’s striae)

WenChen Wang

Erosive lichen planus

WenChen Wang

Plaque type lichen planus

WenChen Wang

Erosive lichen planusDesquamative gingivitis

WenChen Wang

Lichen planus

WenChen Wang

Bullous Lichen Planus

If severe liquefaction, then bullae formed;in very severe case, then disseminated erosions.

WenChen Wang

D.D.1. White sponge nevus

White sponge nevus usually appears at birth (OLP : 70% after 40 yrs.)

D.D.2. Geographic tongue

Geographic tongue -- red center with a slightly raised white border: rapidly (in a few days) change site and shape OLP , if change, take longer time

WenChen Wang

D.D. 3. LeukoedemaLeukoedema if has wrinkles, stretching test

can be used to D.D. with Wickham’s striae.

D.D. 4. Linea alba Patient sucking cheeks habit, then oft

en has linea alba and mimic Wickham’s striae: asking about patient’s habit.

WenChen Wang

D.D. 5. Lichenoid reactionsHistory of taking drugs:

a. systemic treatment with streptomycin, tetracycline, hypoglycemics, diuretics, indomethacine….

b. dental restorative materials: dental gold, mercury, silver alloys.

WenChen Wang

Papules Lichen Planus

WenChen Wang

no treatment jf no discomfort, examined periodically.clinical discomfort ( i.e. burning , tenderness, soreness of oral mucosa): topical steroidsevere cases: systemic administration of sedative and cortisone.

Management: OLP

WenChen Wang

Squamous cell papilloma, papilloma

WenChen Wang

Squamous cell papillomaFeatures: 1. exophytic, papillomatous shape, pedunculated with rough, cauliflower-like pebbly surface, deep cleft formation. 2. In oral cavity, usually < 1 cm

3. site: tongue (33%), palate, buccal mucosa, gingiva, lips, mandibular ridge, mouth floor

WenChen Wang

Squamous cell papilloma

1. age: most 21-50 yrs (<40yrs)2. Not usually in oral cavity, 3. malignant

change: very rare (no dysplastic changes)

4. color (depends on whether chronic irritation)hyperkeratosis or not white or pink.

WenChen Wang

Verrucous hyperplasiaExophytic mass (a proliferative epithelial lesion), like papilloma.

Precancerous lesionEpithelial hyperplastic fold towards mucosa surface.

If malignant change: towards underlying connective tissue

(some scholars believe: VH =CA).Betel nut chewing habit in Taiwan

WenChen Wang

Verrucous hyperplasis

WenChen Wang

Verrucous hyperplasis

*management:surgical removal. microscopic findings: confined the final diagnosis.

WenChen Wang

Verrucous carcinoma1. an exophytic type of low-grade SCC. 2. features: 1). most sites: mandibular labial and bu

ccal vestibule and mucosa. 2). older ages: average 60-70 yrs. 3). may be very large papillary mass or fl

at covered whole mucosa (sessile base). 4). color depends on the amount of kerat

in: pink or white. 5). may be moderately firm, but not so h

ard like invasive CA.

WenChen Wang

Verrucous carcinoma

3. Management: 1). wide excision:5-yr survival rates as high

as 75%. 2). followed-up carefully: a tendency for

multifocal tumors to develop after excision. 3). radiation: not very successful due to

low grade tumor, on the contrary, radiation may induce malignancy.

WenChen Wang

Verrucous Ca.

WenChen Wang

Distinguishing histologic features between VH and V ca:

s: VH, sharp varity; b: VH, blunt varity; c: V. ca

WenChen Wang

Verruca vulgaris

1. exophytic growth of the epithelium: very common lesion of the skin, rare in the oral cavity. Induced by HPV.

2. features:site: skin, vermillion border, rarely

on labial or buccal mucosa or tongue.

WenChen Wang

Verruca vulgaris (common wart)

WenChen Wang

D.D. with papilloma and verrucous vulgaris

verrucous vulgaris: usually on skin, rarely in the oral cavity.

…sessile base vs. pedunculated (papilloma).

…round eosinophilic bodies in the cells ( in prickle cell layer and granular cell layer) : viral inclusion bodies( not seen in papilloma).

WenChen Wangverrucous vulgaris

Squamous cell papilloma

WenChen Wang

Squamous cell carcinoma

WenChen Wang

Oral Candidiasis Moniliasis, candidosis Classification

A. Acute pseudomembranous (Thrush)

B. Acute atrophic (antibiotic sore mouth)

C. Chronic atrophic (denture-associated

stomatitis)

D. Chronic hyperplastic (chronic

mucocutaneous candidosis; candidal

leukoplakia)

WenChen Wang

Chronic candidiasis

if low grade infection by Candida albicans:

due to long term irritation: ( i.e. tobacco smoking) increase keratin production and retention hyperkeratosis, like leukoplakia can not be scraped off

WenChen Wang

Chronic Mucocutaneous Candidiasis

WenChen Wang

Acute pseudomembranus typecandidiasis

WenChen Wang

erythematous cndidiasis

WenChen Wang

Factors predisposing to oral candidiasis

1. Systemic factors: physiologic old age, infancy, pregnancy

2. Endocrine disorders: diabetes mellitus, hypothyroidism

3. Nutritional deficiencies: iron, foliate, or vitamin B12 deficiency

4. Malignancies: acute leukemia, agranulocytosis, 5. Immune defects, immuosuppression, AIDS, thy

mic aplasia, corticosteroids

WenChen Wang

Candida Albicans

WenChen Wang

Candidiasis

Management: a. discontinue broad spectrum antibiotics treatment, use more s

elective ones. b. anti-fungal therapy, ex. nystatin

suspension c. treatment of primary diseases.

WenChen Wang

AIDS

1. Pseudomembranous cadidiasis,

2. Erythematous candidiasis: lesion on the tongue: along the mid-line and the filiform papilla atrophic.

3. If esophageal candidiasis: may be AIDS.

WenChen Wang

Oral Candidiasis as the first manifestation of HIV Infection

WenChen Wang

Submucous fibrosis

1. a fibroelastic change of the lamina propria. 2. epithelial atrophy: stiffness of the oral mucosa: trismus and inability to

eat. 3. etiology: unclear, strong irritating foods and vitamin B def., protein def., betel nut chewing.Precancerous condition

WenChen Wang

Submucous fibrosis1.Clinical: 1). burning sensation: vesicles, ulcerations or recurrent stomatitis. 2). stiffening of certain areas: difficult to opening the mouth and swallowing. 3). like systemic sclerosis or scleroderma. 4). mucosa: finally became blanched and opaque, fibrotic bands. 5). age: usually 20-40 yrs.

WenChen Wang

Submucous fibrosis

WenChen Wang

2. Microscopic findings: severe atrophic, rete

pegs disappeared, epithelial atypia, disappearance of fibroblasts, blood vessels obstructed or narrowed.

3. Dense collagen bundles aggregation

Submucous fibrosis

WenChen Wang

Submucous fibrosis

3. Treatment:

1).could be precancerous. 2).systemic corticosteroid and local hydrocortisone to alleviate pain.

WenChen Wang

Sloughing Pseudomembranous Necrotic Lesions

May be scraped off the mucosa with a tongue blade, leaving a raw bleeding surface.

WenChen Wang

PlaquePlaque (material alba): *dental plaque is on the

tooth surface, not easily been washed off with water.

WenChen Wang

Chemical burns

Chemical burns:1. some analgesics put in the oral cavity:

mucosal lesions: aspirin burn etc. or causatic agents (phenol, silver nitrate) used by dentist.

2. diagnosis: history.3. treatment: protective coating: Orabase,

bland diet; systemic analgesics.

WenChen Wang

chemical burn

WenChen Wang

ANUG

Acute Necrotizing Ulcerative Gingivitis (ANUG, Vincent’s infection, Trench mouth)

1.inflammatory disorder of gingiva, necrotic ulcerative destruction of the free gingiva, crest and inter-dental papillae.

WenChen Wang

ANUG

WenChen Wang

ANUG2. Predisposing factors are very important:(i). mainly due to decrease resistance to infe

ction(ii).gingivitis and periodontitis: poor oral hyg

iene (iii). Stress these lead to overgrowth of the normal fl

ora or superinfection by anaerobic and fusiform bacilli

and spirochete (should be P.i.).

WenChen Wang

ANUG

Differential diagnosis: 1.punched out defects of the inter-de

ntal papillae: pathognomic for ANUG. 2.diffuse gangrenous stomatitis: nec

rotic gangrenous process spread to oral mucosa except interdental papillae and marginal gingiva: systemic disorders??

WenChen Wang

ANUG

Management: 1.mainly aimed to : superinfection b

y anaerobic fusiform and spirochetes, poor oral hygiene (gingivitis and periodontitis), and low resistance to infection.

WenChen Wang

ANUG

(i). antibiotics (penicillin 500mg, q.i.d. >5days).

(ii). careful scaling, curettement and debridment ( best 24-48 hrs after antibiotics treatment).

(iii). oral rinsing with a solution of 3% H2O2

in saline (1:3), 12x daily. (iv). recontouring of the gingiva if necessa

ry.

WenChen Wang

Candidiasis

WenChen Wang

Angular cheilitis

Predisposing factors: decreased vertical dimension of dentures, anemia, vitamin B deficiencies

Infection with Candida albicans, other microorganisms

Treatment: eliminate predisposing factors, antifungal ointment (nystatin)

WenChen Wang

Angular cheilitis

WenChen Wang

Yellow Lesions

Fordyce’s granules: a collection of sebaceous glands, covered by normal mucosa. clinically: small elevated granules, color from whitish yellow to yellow.

WenChen Wang

Fordyce’s granules

1. in oral cavity: buccal mucosa (usually bilateral), retromolar pad, labial mucosa.

2. usually no ulceration, looks like cheese.

3. histological features: like normal sebaceous glands of skin.

4. 50-80% population may have, a benign lesions, patient cancer phobia.

WenChen WangFordyce’s granule

WenChen Wang

Lipoma

1. the most common benign neoplasms, but rarely in oral cavity.

2. mature fat cells under skin tissue.

3. usually after 40 yrs., peak at 50 yrs (middle age).

WenChen Wang

Lipoma 4. in oral cavity: most on buccal muco

sa and mucobuccal fold, then tongue, floor of the mouth and lips.

5. usually yellow color, but many shapes: sessile, pedunculated; usually smooth surface, no-ulcerated (except with trauma).

6. palpation: nontender, soft, felling like cheese.

7. usually single lesion.

WenChen Wang

Lipoma

WenChen Wang

Lipoma1. Microscopic findings: mature fat cells

within a connective tissue capsule, fibrous stroma divided into lobules, blood vessels in the septa.

2. Treatment: excision for large lesion, no treatment for small lesions.

WenChen Wang

Epidermoid and Dermoid Cysts

1. a kinds of developmental anomalies. Cystic teratoma comes from germinal epithelium.

2. any place in the body, not usually in the oral cavity.

3. if in the oral cavity: patient may have swelling of his/her floor of the mouth.

4. at head and neck: most at floor of the mouth, then at submaxillary and submental areas.

WenChen Wang

Epidermoid and Dermoid Cysts5. any ages, but mostly discovered in 15-3

5 yrs. old, nontender, various sizes, non-fixed, if no trauma: smooth surface.

6. histology classification depends on cystic contents:

(i). epidermoid cyst: fluid, keratin, non- specific structures. (ii). dermoid cyst: sebaceous materials, keratin. (iii). Teratoma: many elements from different germinal layers: bone, muscle, teeth etc.

WenChen Wang

Epidermoid cysts

Dermoid Cysts

WenChen Wang

Epidermoid and Dermoid Cysts

Differential diagnosis: ranula, thyroglossal duct cyst, cystic h

ygroma, brachial cleft cyst, cellulitis, tumors, fat masses.

Thyroglossal duct cyst

WenChen Wang

Oral Ulcers and Fissures

Recurrent aphthous ulcer (canker sore) (RAU) and Intraoral recurrent ulcer of herpes simplex (IRHS)

Both are: (i). easy recurrent painful ulcer (superficial), each time lasts 1-2 wks; (ii). usually have tender LAP (iii). spontaneous heal, no sequelae (scar formation).

WenChen Wang

RAU and IRHS

Differences: (i). Etiology:RAU: psychic, allergic, microbial, traumatic,

endocrine, hereditary and autoimmune mechanisms.

IRHS: HSV infection, may be subclinical infection, virus became latent in nerve endings or ganglions reactivation epithelial cells lesions.

WenChen Wang

RAU and IRHS

(ii). Sites:RAU: freely movable mucosa (non-keratini

zed): lips, buccal mucosa, tongue, mucobuccal fold, floor of the mouth, soft palate.

IRHS: fixed mucosa (keratinized): hard palate, gingiva and alveolar ridge.

WenChen Wang

RAU and IRHS

3. Management: a. in general, no treatment, heal after 1-2 wee

ks; b. some ones used:RAU: tetracycline mouthwash and cortisone in Orabase; analgesics (may be).IRHS: Vira-A or Zovirax cream (Acyclovir)

WenChen Wang

Minor type of Recurrent aphthous ulcer

WenChen Wang

Major recurrent aphthous ulcer

WenChen Wang

Herpetiform recurrent aphthous ulcer

WenChen Wang

Primary herpetic gingivostomatitisPrimary herpetic gingivostomatitis

WenChen Wang

Recurrent herpes labialis

WenChen Wang

Herpetiform recurrent aphthous ulcer

WenChen Wang

Tuberculosis (TB)

1. infectious organisms: Mycobacterium tuberculosis.

2. at oral cavity: uncommon, if any, rarely are primary lesion,

but secondary to pulmonary lesions.3. pulmonary lesion: sputum to small injury site

of mucosa tissue, or through hematogenous spread to submucosa then proliferation to ulceration.

4. mostly at tongue then palate, lips, buccal mucosa, gingiva, frenula.

WenChen Wang

TB

5. irregular, painful ulcer, became larger slowly

6. easily to have trauma then can be mistaken as traumatic ulcer or carcinoma

7. sometimes without ulcer; if on gingival, then diffuse, hyperemic, nodular or papillary proliferation

8. sometimes involved bone (maxilla or mandible) through hematogenous spread.

WenChen Wang

Tubercurosis

WenChen Wang

Tubercles of epitheloid cells, Langhan’s giant cells, mononuclear cells in periphery

WenChen Wang

Ulcers secondary to systemic disease

1. History of predisposing disease or history revealing information suggesting presence of disease.

2. Example: Steven-Johnson syndrome (Erythema multiform).

Differential Diagnosis of Ulcers

WenChen Wang

Erythema multiform

1. involves lips with multiple red lesions (papule or bullae): rupture: raw, painful lesions

2. other sites including skin lesions; before disease, may have HSV, taken drugs (antibiotics, contraceptives, barbiturates), post-radiation therapy ( i.e. ulcerative colitis patient).

WenChen Wang

Ulcers from odontogenic infections

Ulcers from odontogenic infections: 1. suspicion of ulcer on alveolar or pala

te 2. digital pressure on alveolus or tooth

elicits pus from ulcer 3. trace sinus with gutta percha cone:

x-rays to isolate involved teeth.

WenChen Wang

RAU Recurrent aphthous ulcer: 1. yellowish ulcer, 0.5-2 cm diameter,

with narrow erythematous halo 2. on loose mucosa surface.

IRHSIntraoral recurrent herpes simplex: 1. cluster of small punctuate ulcers

(< 0.5cm) 2. on bound mucosa.

WenChen Wang

Traumatic ulcers

History of trauma or presence of potential etiologic agent.

WenChen Wang


1. high suspicion if patient is male over 40, heavy drinker or smoker

2. no evidence of trauma or systemic disease; negative serologic findings

3. risk factors involved: alcohol, betel quid chewing, smoking

WenChen Wang


WenChen Wang

民國九十七年台灣地區十大癌症死因死亡原因每十萬人口死亡人數

死亡率 1 肺癌 33.8 7,771 2 肝癌 33.3 7,651

3 結腸直腸癌 18.5 4,266 4 女性乳癌 13.5 1,541 5 胃癌 10.0 2,292 6 口腔癌 9.6 2,218 7 攝護腺癌 7.7 892 8 子宮頸癌 6.2 710 9 食道癌 6.2 1,433 10 胰臟癌 5.9 1,364

台灣地區民國 97 年有 38913 人死於癌症，平均每 13 分半就有 1 人死於癌症

98.6.1798.6.17 公佈公佈

WenChen Wang

民國九十七年男性與女性十大癌症死因

男性女性 1 肝癌 1 肺癌 2 肺癌 2 肝癌 3 結腸直腸癌 3 結腸直腸癌 4 口腔癌 4 女性乳癌 5 胃癌 5 胃癌 6 食道癌 6 子宮頸癌 7 攝護腺癌 7 胰臟癌 8 胰臟癌 8 卵巢癌 9 鼻咽癌 9 白血病10 非何杰金淋巴癌 10 非何杰金淋巴癌口腔癌男性死亡 2,079 人

98.6.1798.6.17 公佈公佈

WenChen Wang資料來源 :行政院衛生署　製圖：王文岑　

台灣口腔癌死亡人數統計

wenchen wang 1. white lesions of the oral mucosa 2. solitary oral ulcer and fissures 3. yellow...

Documents