Author: Dr.Mehnaz

MALIGNANT MELANOMA

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A neoplasm of epidermal melanocytes and third most common cancer of skin.

▪️Arises in preexisting mole. Appearance – Large, flat, spreading lesion; deeply pigmented Nodule

🔹Precursor Lesions:

(i) Congenital Nevi

https://dentowesome.wordpress.com/2020/05/18/oral-nevi/

(ii) Dysplastic Nevi (Atypical Mole)

(iii) Lentigo Maligna: Also called as Hutchinson’s freckle, is a tan or black on the skin that looks like a freckle.

  • Grows slowly
  • Dark, thick, nodular, mottled
  • Seen on one side of the face of an older adult who had a large amount of sun exposure.

🔹Etiology:

• Genes in the development of Melanoma:

p16, p19, 12q15
Variations in the melanocortin-1 receptor gene

• Phases in the growth of Melanoma:

  1. Radial
  2. Vertical

🔹Classification:

1. Superficial spreading Melanoma:

  • most common type (65%)
  • Radial growth phase – premalignant melanosis/pagetoid melanoma in situ
  • Vertical growth phase – Increase in size, color, nodularity/ulceration
  • Lesions are usually flat, scaly or crusty & 2 cm in diameter
  • Found in trunk & back of Men; Legs of women
  • Median age of occurrence – 50’s

2. Lentigo Maligna Melanoma:

  • Least serious form
  • More in women
  • Macular lesion on malar skin of middle-aged and elderly

3. Nodular Melanoma:

  • Exhibits only vertical growth phase
  • Sharply delineated nodule, may be pink/black
  • Occur in men on skin of head, neck & trunk
  • Looks like blood blister

4. Acral Lentiginous:

  • Also called muco-cutaneous Melanoma
  • Less common with fair skin
  • Palms of hands, soles of feet, mucous membrane, nail beds
  • Median age of occurrence – in 50’s & 60’s

Assessing the ABCDE’s of Moles

A – Asymmetry
B- Border irregularity
C – Color irregularity
D – Diameter
E – Elevation
Image Source: IG|medical.docs

🔹Oral Manifestations:

  • Age: 55 yrs
  • Sex: M>F
  • Site: Palate/Gingiva
  • Appearance: Deeply pigmented area; ulcerated/haemorrhagic; ⬆️ size
  • Amelanotic melanomas: 5-35% of oral cases

Melanoma stages 5 years survival rates:

  • Stage 0: Melanoma in situ ( Clark level I), 99.9% survival
  • Stage I/II: Invasive melanoma, 85-99% survival
  • Stage II: High risk Melanoma, 40-85% survival
  • Stage III: Regional Metastasis, 25-60% survival
  • Stage IV: Distant Metastasis, 9-15% survival

🔹Treatment depends on stage:

➡️ Metastases that cause symptoms but cannot be removed may be treated with radiation, immunotherapy, targeted therapy, or chemotherapy.

Dr. Mehnaz Memon🖊

References: Shafer’sTextbook Of Oral Pathology; Textbook Of Surgery by S.Das

ERUPTION SEQUENCE OF PERMANENT AND DECIDUOUS DENTITION

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The term eruption is used to denote the tooth’s emergence through the gingiva but the occlusal definition is equal movement of tooth from the dental bud to occlusal contact.

▪️Eruption sequence in Primary teeth:

Upper

  • Central Incisor: 10 months (8-12 months)
  • Lateral Incisor: 11 months (9-13 months)
  • Canine: 19 months (16-22 months)
  • 1st Molar: 16 months (13-19 months)
  • 2nd Molar: 29 months (25-33 months)

Lower

  • Central Incisor: 8 months (6-10 months)
  • Lateral Incisor: 13 months (10-16 months)
  • Canine: 20 months (17-23 months)
  • 1st Molar: 16 months (14-18 months)
  • 2nd Molar: 27 months (23-30 months)

▪️Eruption sequence of Permanent teeth:

Maxillary Teeth

  • Central Incisor: 7-8 yrs
  • Lateral Incisor: 8-9 yrs
  • Canine: 11-12 yrs
  • 1st Premolar: 10-11 yrs
  • 2nd Premolar: 10-12 yrs
  • 1st Molar: 6-7 yrs
  • 2nd Molar: 12-13 yrs
  • 3rd Molar: 17-21 yrs

Mandibular Teeth

  • Central Incisor: 6-7 yrs
  • Lateral Incisor: 7-8 yrs
  • Canine: 9-10 yrs
  • 1st Premolar: 10-12 yrs
  • 2nd Premolar: 11-12 yrs
  • 1st Molar: 6-7 yrs
  • 2nd Molar: 11-13 yrs
  • 3rd Molar: 17-21 yrs

Dentowesome 2020 @dr.mehnaz

References: Textbook-Pediatric-Dentistry-Nikhil-Marwah

CLINICAL CONSIDERATION OF PULP

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Image source: info.dentis

➡️ For all operative procedures, the shape of pulp chamber & its extensions into the cusps, pulpal horns is important.

➡️ In some developmental disturbances the pulpal horn projects high into the cusps & exposure of pulp can occur when it is least anticipated.

➡️ Pulpitis is the response of the traumatized pulp with trauma being the result of a bacterial infection as in dental caries or physical trauma to tooth structure.

➡️ Pulpitis in milder form could result in focal reversible pulpitis & may progress if left unchecked to acute & chronic forms of pulpitis.

➡️ Well vascularized pulpal tissue may at times in carious molar teeth of young adults & children with open apex exhibit a form of hyperplasia seen clinically in exposed pulp chamber as a protruding red mass of granulation tissue called pulp polyp or chronic hyperplastic pulpitis.

➡️ Inflammation within pulp may also sometimes result in a condition called pulp polyp, internal resorption or pink tooth.

➡️ Pulp infection can spread apically into PDL causing granuloma, abscess, cysts.

➡️ Pulp stones lying at the opening of the root canal may cause difficulty to locate the root canals.

➡️ A necrotic pulp can cause spread of disease to periodontium through an accessory canal.

➡️ Pulp capping is successful in non-infected or minimally infected accidentally exposed pulp in individuals of any age.

Source: Internet, Grossman’s Textbook of Endodontics

Dentowesome 2020 @ dr.mehnaz