Benign and Malignant Lesions

of Jaw

DR KHAIRY ABU ZANT

Key points

• Swelling of oral cavity may arise from surface epithelium or

alternatively arise from pathology of underlying connective tissue
structures.
• Most oral neoplasms are benign. Fibroma is the most common soft
tissue tumor of oral cavity.
• Leukoplakia is the most common precancerous condition of oral
cavity. Leukoplakia is strongly associated with smoking.
• Cancer of the head and neck is the fifth most common type of cancer
in the world. Oral squamous cell carcinoma is the most common type
of oral cancer.
Introduction

• Benign, malignant, and reactive lesions of oral cavity present clinically

as swelling/growth or an ulcerated swelling.
• Oral tissues are vulnerable for benign or malignant growth due to
factors such as trauma, infection (bacterial/viral/fungal), local
irritation, smoking, alcohol misuse, or genetic damage.
• Although clinical and/or radiological details provide a clue in
diagnosis, biopsy is required for arriving to a final definitive diagnosis,
because some of the swellings may be associated with dysplastic
features that may require an intensive surgical management.
 List of benign and malignant oral lesions
Potentially Malignant Reactive Lesions Epithelial Tumors Connective Tissue Tumors
Disorders
• Leukoplakia • Pyogenic granuloma •Benign tumors •Benign tumors
• Erythroplakia Oral • Peripheral giant cell • Squamous papilloma • Fibroma
• submucous fibrosis granuloma Perpheral • Verruca vulgaris • Lipoma
• Lichen planus • ossifying fibroma (common wart) • Neurofibroma
• Epulisfissuratum • Focal melanosis (oral • Neurilemoma
(inflammatory fibrous melanotic macules) • Hemangioma
hyperplasia) • Mole (aquired • Lymphangioma
• Inflammatory papillary melanocytic nevus) • Osteoma
hyperplasia • Keratoacanthoma •Malignant tumors:
•Malignant tumors: • Fibro sarcoma
• Oral squamous cell • Osteosarcoma
carcinoma
• Verrucous carcinoma
• Basal cell carcinoma
• Melanoma
Diagnostic approach for swelling

• The tumors can originate from epithelial or mesenchymal tissue and may be the result of
inflammatory, neoplastic, developmental, or systemic diseases.
• The first step in diagnostic approach for oral swelling is to check whether the swelling is arising from
surface epithelium or, alternatively, arising from pathologic changes from the underlying soft tissue
(ie, fibrous, fat tissue, blood vessels, lymphatic vessels, nerves, cartilage, or bone), resulting in
secondary elevation of surface epithelium/tissue.
• The second step is to categorize them into benign, malignant, inflammatory, or reactive growth.
1. The swellings that are movable, firm, and not indurated are in the benign category.
2. The swellings that are fixed, indurated, ulcerated, or ulceroproliferative are likely to be malignant
type.
3. The swellings that are either tender or painful with or without sinus/fistulation are probably of an
inflammatory origin.
4. The swellings that occur secondary to injury are reactive lesions and may be associated with or
without pain.
• Third step is to evaluate clinical parameters such as surface appearance of swelling,
location, consistency, and the presence or absence of pain. The swelling observed on oral
tissues may be a regular swelling or one of the following types: papillary, verrucous,
dome-shaped, papule, polypoid, diffuse, or multifocal
• Fourth step is evaluating status of lymph nodes.
1. Lymph nodes that are palpable and hard and fixed to underlying structure are likely to
be an association of malignant condition.
2. Lymph nodes that are palpable and soft and movable favor benign growth association.
3. Tenderness/pain associated with lymph node palpable is the characteristic of
inflammation.
• The presence and absence of lymph node cannot differentiate benign from malignant
conditions.
Description on the various appearances of
swelling
Papillary The swellings that appear as fingerlike surface
projections.
Verrucous The swellings that have multiple fingerlike appearance
but characterized by more irregular surface.
Dome-shaped These are oval-shaped swellings with rolled margin and a
central pit that may or may not be plugged with
keratinaceous material.

Papules These are small swellings that are <0.5 cms and are
usually multiple in number.
Polypoid These are similar to papules but exceed 1 cm in growth
size and tend to be multifocal.
Nodular These are raised solid lesions that are >5 mm in
diameter.
Macule Focal area of color change, which is neither elevated nor
depressed to adjacent mucosa.
Diffuse Swellings that are characterized by their multifocal
appearance.
• The fifth step is to formulate differential diagnosis based on clinical
details and plan for investigation for arriving at a final diagnosis
through microscopic examination, that is, biopsy
•  smooth, soft, pedunculated mass with bleeding tendency ,not
ulcerated, without fistula
• painless, lobulated
• Heavy calculus
• Location
• Color
• Growth and duration
• LN
• Pyogenic granuloma