 Hello everyone, welcome back to another session in dentistry and more today. We have basal cell carcinoma BCC which is also known as rodent ulcer Which is a malignant condition in epithelial origin And it most commonly seen on the exposed surface of skin. So let's learn basal cell carcinoma and its detail So rodent ulcer which is most frequently develops on the exposed surface of the skin face and scalp okay skin face and scalp in the age group of middle or elderly so middle or elder age group and Also, it is peculiar in Fair skinned people Okay, so it is a malignant condition or carcinoma which is seen on the exposed surface of skin face and scalp in middle or elderly people and Especially in the fair skinned group of people it is a slow growing and The metastasis is very rare. Okay This is slow growing malignancy and metastasis is very rare in this Malignancy but can cause a significant local destruction So the most common etiology is UV light exposure. That is chronic sundry exposure people who work or people who are exposed to the sunlight every day or very chronic manner and the ionizing radiation Like x-rays those who are exposed to ionizing radiation and Chemicals such as arsenic people who are exposed to the chemical those were in industrial area or industrial Job where the arsenic is involved and people with immunosuppression Immunocompromised people are at risk of this malignancy And also syndromes like zero derma pigment tourism and nevoid basal cell carcinoma syndrome Nevoid BCC syndrome and Zero derma pigment tourism Zero derma pigment or some all these are etiology of BCC So BCC is thought to arise from pluripotent stem cells of the basal cell layer That is why that peculiar name basal cell carcinoma Which is arising from the basal cell layer of epidermis as well as the follicular structures such as hair follicle stem cells Well moving on to the clinical features it is most frequently in the fourth decade of life First fourth decade and male to female ratios two is to one Moscow in male group than female and It is mostly affecting the Middle third of the face Okay, middle third not the upper third or lower third It is affecting the middle third of the face and it does not arise from the oral myocosal So it is not seen intra orally Except for invasions from the adjacent skin surface to the intraoral so it is not Seen on or it is not erasing from the oral myocosal. So intraoral lesions are very rare So there are sub types of basal cell carcinoma one is nodular nodular basal cell carcinoma Which is most common? So this nodular basal cell carcinoma it begins as a slightly elevated papule With a central depression with a central depression Which ulcerates heels over and then breaks down again. So very mild trauma may cause bleeding Eventually the crusting ulcer which appears superficial which develops a smooth rolled border representing Tumor cells spreading laterally beneath the skin. So there will be lateral spreading beneath the skin and There will be Pigmented type which is the second one pigmented basal cell Carcinoma the second type Pigmented Basal cell carcinoma. Okay. So pigmented basal cell carcinoma is in addition to the features seen in the Nodular type this type contains black or brown pigmentation Black or brown pigmentation. So almost clinical features are same as nodular type with a papule with a central depression ulceration and the Lateral spreading beneath the epithelium along with black and brown pigmentation And it is more commonly seen in dark skinned people Next we have Cystic basal cell carcinoma Cystic basal cell carcinoma which may contain translucent blue gray cystic nodule blue gray cystic nodule and Which mimic benign cystic lesions Okay That is cystic basal cell carcinoma. Now we have superficial that is a fourth type superficial bcc Which presents as a scaly patches Or papules commonly on the trunk That are pink to red brown in color pink to red brown in color Often with central clearing and a thread like border Okay, that is superficial bcc now. We have micro nodular bcc micro nodular Micro nodular This micro nodular bcc which is very aggressive type which is less prone to ulceration It may appear as yellow white when stretched and is firm to touch It may have a seemingly well defined border. Okay And the last type is infiltrating bcc Morphe form and infiltrating Morphe form and infiltrating type Infiltrating bcc morphe form and infiltrating type These are aggressive types with the sclerotic Papule or plagues which may be mistaken for scar tissue Border is usually not well defined and often extends well beyond the clinical margins. There will be ulceration bleeding and crusting. Okay So these are the six types. So the first one was nodular then pigmented cystic then superficial micro nodular Morphe form and infiltrating bcc These are the six types of basal sulcusenoma Now in histologic features in nodular and pigmented types the tumor cells called basilloma cells Basilloma cells Okay in these two types the basilloma cells typically have large oval Hypo hypochromatic nuclear with little cytoplasm. Okay large nuclear That is hypochromatic nuclear with a little cytoplasm And these are arranged in well demarcated islands which appear to erase from the basal layer and overlaying epidemis hand which invades into the underlying epidemis underlying dermis, sorry Whereas in pigmented type the benign melanocytes in and around the tumor which produce large amount of melanin. Okay So there will be melanocytes Which is present in and around the tumor And the superficial type the lobules of tumor cells drop from the epidermis in a multifocal pattern. Okay And the morphe form type Which exhibit infiltrating thin strands of tumor cells in a dense fibrous trauma So these strands of infiltrating type are thicker and have a spiky irregular appearance The micro nodular type which appears as a small nodular aggregates of basilloid cells Okay So when this basal sulcusenoma is mixed with squamous sulcusenoma Which is known as basosquamous carcinoma basosquamous carcinoma So those are the histology explanation of the various types Now let's move on to the treatment part of basal sulcusenoma the small lesions such as less than 1 centimeter lesions we go for surgical excision or laser ablation or electro dissection and cure at age With 5 mm margins of normal appearance skin. So if it is a 1 centimeter, so we take a 5 mm normal tissue also for the excision So if it is a large lesion, we need to go for radical surgery or radiation therapy For sclerotin type or recurrent lesions we need to use a micrographic surgery Which uses like a frozen section evaluation of specially mapped and marked surgical specimen to determine whether tumor tissues has been left behind so that is micrographic surgery micrographic surgery it defines the borders very clearly because of the frozen section evaluation And prognosis is good since recurrence is very It's not common and metastasis is very rare And death if occurs is usually the result of patients Negligence and local invasion tend to the vital structures So that is all about the basal cell carcinoma or rodent ulcer. So we talked about the clinical features the six types its differentiation between clinical features and the histological features and finally The treatment part, okay, so I'll come up with a new topic in dentistry and more. Thank you Hello, everyone. Welcome back to another session in dentistry and more So today we have epidermoid carcinoma Which is also known as squamous cell carcinoma or scc So which is the most common malignant neoplasm of the oral cavity and It is a neoplasm which exhibits squamous differentiation As characterized by the formation of keratin and the presence of intercellular ridges So keratin formation and Intercellular ridges And most specifically Squamous differentiation So let's learn the most common malignant neoplasm of the oral cavity So as I mentioned squamous cell carcinoma, it is a malignant neoplasm exhibiting Squamous differentiation and characterized by formation of the keratin And or the presence of intercellular ridges So the male to female ratio is 2 is to 1 most commonly seen in males And mainly found in the elder age group after the fourth decade. So after the fourth decade is most Commonly seen in male group and the mortality rate is lowest for lip cancer And highest for the tongue So lip is the lowest and highest is for tongue cancer So it could be anywhere on the tongue Like Lips, tongue, buccal mucosa, floor of the mouth, palate And most common site is tongue and the least one is lip So etiology is as we all know tobacco Is in its various form like smokeless tobacco Which is the main cause especially when coupled with excess alcohol And also high exposure to ultraviolet radiation is a pretty spursing factor Also locoplickia, poor oral hygiene Diet with low levels of vitamin A and vitamin C And inadequate consumption of fruits and vegetables Which is also a contributing factor Patients who are immunosuppressed They are also in predisposed group And rare conditions like zero derma pigmentosa And also risk factor And also risk factor for oral cancer Has been shown to increase in the presence of Human papilloma infection So these are the etiological factors of squamousal carcinoma Whereas moving on to clinical features The all cancers have two very characteristic features in the form of One is ulceration And the second one is an inturated margin So these are the typical two striking features of squamousal carcinoma Now in histologic types we have three major types in histologic classification Histologic types are well differentiated Well differentiated Well differentiated is slightly towards a malignant region Or the prognosis also is better in well differentiated group It consists of sheets and nests of cells with obvious origin from the squamous epithelium And cells are usually large and show a distinct cell membrane Although intercellular bridges often cannot be demonstrated Nuclei are large and may demonstrate a good deal of variability in staining Mitotic figures may be found many of which are atypical And the most prominent features are Individual cell individual cell keratinization Okay, individual cell keratinization and the formation of keratin pulse So these are the two striking features of well differentiated group Whereas the moderately differentiated that is the second one moderately differentiated Moderately differentiated Where the tumor resemblance to the squamous epithelium is less pronounced This is more of squamous epithelium It is less pronounced towards squamous epithelium And the characteristic shape of the lesion That is the shape of the cells not lesion cells may be altered And the growth rate is more rapid Compared to the well differentiated And greater numbers of mitotic figures And they fail to form keratin The third type is poorly differentiated Poorly differentiated is very little resemblance to the cell of origin And will present diagnostic difficulties The prognosis of poorly differentiated is very Difficult or very minimal I mean the recovery is very difficult with respect to poorly differentiated group And this is like a stage 3 or 4 cancer This is the beginning stages stage 1 and stage 2 And metastasis involve chiefly Submaxillary and superficial Deep cervical lymph nodes So submaxillary and deep cervical lymph nodes Towards these nodal groups that will be metastasis And the basic three types are well differentiated Moderately differentiated and poorly differentiated So as I mentioned Scrum cell, Casinoma are of various type The first one is Casinoma of lip Casinoma of lip which occurs in elderly men Especially in the lower lip And it is most common cause as we all know it is tobacco Or through pipe smoking Clinical features begins with Or begins on the vermilion border of lip On one side of the midline And often starts as a small area of thickening or induration And ulceration It enlarges then create a small crater like defect Or produce an exophytic proliferative So sometimes it will be exophytic Or sometimes a crater like depression So it is generally slow to metastasis And this if it is occur then it is going to Ipsilateral nodes and involves a submental or submaxillary nodes So contralateral metastasis may occur only if the lesion is near the midline Otherwise it is going only to the one side Okay, if it is going either side it should be on the towards the midline And treatment we do either surgical excision or x-ray treatment And usually it has a good prognosis Whereas the tongue which has the least prognosis So it is suggested that the syphilis and tongue causinoma There is a relationship but nothing has proved yet So clinical features are a painless mass or ulcer Which might become painful if it is secondly infected It begins as a superficially inturator ulcer with slightly raised border And may develop into fungating exophytic mass Fungating exophytic mass that is in tongue Okay, so there will be an infiltration to the deeper layer of tongue Producing fixation and enturation Develops on the lateral borders or the ventral surface of the tongue So lesion on the posterior portion are usually of a higher grade of malignancy And easily go on metastasis and offer a poor prognosis If it is on the posterior part of tongue Because of its inaccessibility for a treatment So anterior part we can go for a surgical excision Or the posterior part the accessibility And it is a poor prognosis when it is on the posterior part Poor prognosis And treatment and as I mentioned treatment is very difficult As the efficacy of it depends on the efficacy of surgery And prognosis is also very poor So the squamousal cosinoma the least prognosis is seen in tongue So whereas the cosinoma of floor of the mouth Floor of the mouth When smoking especially pipe or cigar it is the most important in etiology It is an indurated ulcer of weeding size Situated on one side of the midline More frequently on the anterior portion of the floor Because its location early extension into lingual mucus of the mandible And then it goes to the tongue even to the sub maxillary or sublingual glands So sometimes it may produce limitation or the motion of the tongue Or slurring of the speech Slurring of the speech or tongue movements It may affect these two things Tongue movements and slurring of the speech So contralateral metastasis is common as a primary lesion occurs mostly on the midline So surgical part is also Like we need to go for a radiation therapy It gives better results than the surgery Whereas the cosinoma of Bacal mucosa So it is most commonly seen in men And etiology is in area against the person has habitually carried a kid of chewing tobacco So smokeless tobacco where they used to keep in Bacal vestibule And it creates a change in the epithelium Which leads to scomersal carcinoma of Bacal mucosa And clinical features usually develops along the inferior to align opposite the plane of occlusion So it is a plane of occlusion So it is seen below the line of occlusion where the Bacal vestibule And where the people usually keeps the tobacco pouches So lesion is often a painful ulcerative one Where the enduration and infiltration of deeper tissue is common Some lesions may even be exophotic And metastasis is very frequent So treatment we need to do a combination of surgery and X-ray radiation The carcinoma of gingiva The problem is its similarity to common dental infection Has frequently led to the delay in diagnosis or even misdiagnosis With respect to gingiva because the periapical lesions, periapical abscess All those may cause the delay in diagnosis So carcinoma of gingiva is another problem which commonly found in the mantibular gingiva Which initially present as an area of ulceration Which may be purely erosive or may exhibit exophotic growth Purely erosive or exophotic And it arises more commonly in edentulous areas And fixed gingiva that is attached gingiva is Commonly involved than the marginal gingiva Erosion of the underlying bone is frequent And metastasis is more common from the mantibular gingiva And treatment also similarly we need to combine the surgical and radiation And carcinoma of pallet is not a very common lesion Which the clinical features include poorly defined ulcerated painful lesion on one side of the midline It frequently crosses the midline and may extend laterally to Include the lingual gingiva or posteriorly to Involve the tonsilapilar or even the uvula So that is metastasis also is common Now we wind up the scoma cell carcinoma So scoma cell carcinoma is most common type Which has three different category That is well differentiated moderately differentiated and poorly differentiated Depends on the histologic features And prognosis also inferior with respect to the poorly differentiated So we have scoma cell carcinoma of lip tongue Floor of the motor gingiva bakal mucosa and pallet It is a commonly asked as a cushion So next I'll come up with another carcinoma in dentistry and more Thank you Hello everyone welcome back to another session in dentistry and more So we are continuing our malignant lesions of oral cavity epithelial origin So now we have varucous carcinoma So varucous carcinoma we already learned the benign type that is varucous lesion Or varucous vulgaris which is a benign lesion Which is commonly known as Watt So this is a Wattie variant of scoma cell carcinoma So last session we had covered scoma cell carcinoma in detail So this is a Wattie variant that is a cauliflower like Varucous appearance of scoma cell carcinoma is known as varucous carcinoma So let's learn the details of varucous carcinoma So this varucous carcinoma which is predominantly exophytic overgrowth of well differentiated Keratinized epithelium which is having minimal atypia Okay, which is having minimal atypia And with locally destructive pushing margins at its interface with the connective tissue So that is locally destructive pushing margins Destructive pushing margins at the interface with the connective tissue Clinical features it is commonly seen in elder group with 60 to 70 years Highest incidence and mainly on the buccal mucosa and Ginjaiva are the common sites which appears as a papillary with pebble surface Which is sometimes covered with a white leucoplacic film And these lesions on the ginjaiva it may grow into the soft tissue And invade and destroy the underlying bone Okay, so it may destroy the bone also So regional lymph nodes are enlarged and tender Which simulate metastatic tumor pain and difficulty in mastication are common complaints So this disease has a high occurrence rate in tobacco chewers So tobacco chewing is the most common etiology in all these types of commercial carcinoma And also smokers or snuffers or in patients having ill fitting dangers So growth is usually slow and metastasis occurs late If at all is happening it occurs at very later period It may become more aggressive if it is irradiated In histologic features it may be extremely deceptive And it is mistaken for papilloma or benign epithelial hyperplasia because of its appearance And the epithelial proliferation with down growth of epithelium into connective tissue But usually this without true invasion So the well differentiated hyperplastic epithelium is organized into bulbous rite ridges which shows a little mitotic activity pleomorphism or hyperchromaticism And there will be clef-like spaces which is lined by thick layer of paracarate And paracarate in plucking So paracarate in plucking also occurs extending into the epithelium Okay, this paracarate in plucking will be extending into the epithelium So this clef-like spaces and paracarate in plucking They these two features together constitute the hallmark of veruchus casinoma Okay, so paracarate in plucking and clef-like spaces are the hallmark of veruchus casinoma So this clef-like spaces also lined by paracarate in Okay, so basement membrane is generally intact and usually having a heavy inflammatory infiltrate into the connective tissue So the treatment part is basically a conservative excision And the risk of anaplastic transformation is there if it is radiated So that is all about veruchus casinoma, this is another variant of commercial casinoma which is commonly seen on Bacalmucosa and Jundreva which is a Wattie variant that is a striking feature So veruchus casinoma has two characteristic features that is paracarate in plucking and clef-like spaces which is lined by paracarate Okay, so that is all about veruchus casinoma I will come up with a new topic in industry and more Thank you Hello everyone, welcome back to another session in industry and more Today we have a malignant condition which is known as malignant melanoma which is a neoplasma of epidermal melanocytes So epidermal melanocytes Which is one of the most biologically unpredictable and deadly of all human neoplasma Okay, this is a very deadly neoplasma and which is very unpredictable This malignant melanoma which is the most or the third most common cancer of skin of skin after basal cell casinoma and scoma cell casinoma of K This is about skin So earlier it was believed that melanomas develop in knee-y especially the junctional knee-y But now it is thought that the lesions which were interpreted as junctional knee-y were in fact the pre malignant melanocytic dysplasias Okay, so melanocytic dysplasia So before it was thought to be a junctional knee-y But now it is understood that it is a pre malignant melanocytic dysplasia So certain lesions considered to be pre malignant melanomas are the accurate knee-y, dysplastic knee-y, congenital knee-y and cellular blue knee-y So coming to the etiological factors the environmental factors are sun exposure artificial uv sources socio-economic status, fair skin, red hair and number of melanocytic knee-y all could be the etiological factors. In genetical factors the familial melanoma familial melanoma and zero derma pigmentosa. Okay, there is factors of oral melanomas are unknown basically they have no apparent relationship to chemical, thermal or physical events to which the oral mucosa is continuously exposed. So there are two phases in the growth of melanoma that is a radial growth phase. Okay, first one is radial growth phase. Radial growth phase is an initial phase which may last for many years and the neoplastic process is confined to the epithelium. Okay, radial growth, the neoplastic activity is confined to epithelium only and the second phase is a vertical growth phase. Okay, vertical growth phase which begins when the neoplastic cells populate the underlying connective tissue and in this phase so connective tissue what happens there will be metastasis. So that is the two types of growth seen in malignant melanoma that is the radial growth and vertical growth. Okay, so we have four types of melanoma that is the first one is superficial spreading type superficial spreading melanoma, second one is nodular melanoma, third one is lentigo malignant melanoma and the last one is the acryl lentiginous melanoma. So the clinical features of superficial spreading or SSM is which exist in a radial growth phase called pre malignant melanosis and it present as a tan brown black or admixed relations of sun exposed skin especially the back side and vertical vertical growth phase is characterized by increase in size change in color nodularity and also ulceration. In nodular melanoma which is NM no clinically recognizable radial growth phase and existing solely in a vertical growth phase only the vertical growth. Okay and it present as a sharply delineated nodule with a decrease of pigmentation maybe pink or black which is known as amelanotic melanoma. So amelanotic melanoma is nodular melanoma due to its pigmentation it appear as a pink or black which is known as amelanotic melanoma and predilection for occurrence on the back and head and neck skin of the third one lentigo malignant melanoma or LMM which exist in a radial growth phase which is known as lentigo malignant or melanotic freckle of Hutchinson okay melanotic freckle of Hutchinson and occurs characteristically as a macular lesion on the malar skin of the middle east and elderly Caucasian more common in women okay so this is more common in Caucasian ethnicity and women okay in Malar region. So the last one or the acral lentigo melanoma which is developing on the palms and soles as well as on the toes and fingers which is characterized by macular lentigas pigmented area around a nodule they are extremely aggressive with rapid progression from the radial to vertical growth phase. So the following criteria which helps in clinical diagnosis okay clinical diagnosis we can go for a a b c d e rule so a is the asymmetry b is border irregularity border irregularity c is color irregularity color irregularity okay d is diameter and e is elevation so this is a a b c d e rule in clinical diagnosis of malignant melanoma in border irregularity with blurred nost or ragged edges and color irregularity pigmentation is not uniform black brown red tan white and blue can all appear together diameter greater than six mm growth in itself is a sign okay so that is a a b c d e rule asymmetry border irregularity color irregularity diameter and elevation whereas the oral manifestation it is twice as common in men than in women most commonly it is seen in 40 to 70 group age group predilection for the palate and maxillary gingiva palate and maxillary gingiva and it appears as a deeply pigmented area at times ulcerated and hemorrhagic which tends to increase progressively in size and oral melanomas exist in superficial spreading acro lentigas and nodular types. In histologic features we have malignant cells often as a nest or cluster in groups in an organoid fashion and they have large nuclei prominent nuclei and show a nuclear pseudo inclusion and radial growth phase of superficial spreading melanoma is characterized by presence of large epithelioid melanocytes distributed in a so-called pectoid manner which is known as buckshot scatter okay buckshot scatter buckshot scatter which is nothing but the presence of large epithelioid melanocytes distributed in a pectoid manner so when melanocytes penetrate the basement membrane a host cell response develops which destroys the tumor cell and vertical growth phases characterized by proliferation of malignant cells in the dermis okay and the nodular type is characterized by large epithelioid melanocytes within the connective tissue and tumor cells may invade and ulcerate the overlaying epithelium and penetrate the deep soft tissues whereas a lentigo malignant which is characterized by increased number of atypical melanocytes moving on to the treatment and prognosis the surgical excision for cutaneous lesion should be performed when lymph nodes are involved regional lymph node dissection if tumors are greater than 0.75 millimeter in thickness and located in the so-called band sites that is back arm neck and scalp this is band site so it have a greater tendency to metastasis so surgical excision for oral melanoma jaw resection and lymph node resection should be performed women have a much meta-servable rate up to 50 years and then the rate declines nodular and superficial spreading melanoma have a much poorer prognosis than the lmm tumors which is less than 0.75 millimeter rarely metastasis or it could be rarely cause a reason for death and the oral melanoma have much poorer prognosis than the cutaneous ones so that is all about malignant melanoma so we have discussed the various details and the abcd rule various types its histological features clinical features and finally the treatment and band criteria buckshot scatter appearance so it is a commonly asked ha question so i'll come with a new topic in dentistry and more thank you