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Chapter 18: Disorders of the Head and Neck

Which of the following are true about leukoplakia of the vocal cords?

A. Up to 40% risk of progression to invasive carcinoma.

B. Ulceration is particularly suggestive of possible malignancy.

C. Initial therapy includes antihistamines.

D. Biopsy should be considered only after 6 months of conservative therapy.

Answer: B

Leukoplakia of the vocal fold represents a white patch (which cannot be wiped off) on the mucosal surface, usually on the superior surface of the true vocal cord. Rather than a diagnosis per se, the term leukoplakia describes a finding on laryngoscopic examination. The significance of this finding is that it may represent squamous hyperplasia, dysplasia, and/or carcinoma. Lesions exhibiting hyperplasia have a 1 to 3% risk of progression to malignancy. In contrast, that risk is 10 to 30% for those demonstrating dysplasia. Furthermore, leukoplakia may be observed in association with inflammatory and reactive pathologies, including polyps, nodules, cysts, granulomas, and papillomas. Features of ulceration and erythroplasia are particularly suggestive of possible malignancy. A history of smoking and alcohol abuse should also prompt a malignancy workup. In the absence of suspected malignancy, conservative measures are used for 1 month. Any lesions that progress, persist, or recur should be considered for excisional biopsy specimen. (See Schwartz 10th ed., p. 573.)

Factors associated with increased incidence of head and neck cancers include all of the following EXCEPT

A. Human papillomavirus (HPV) exposure

B. Ultraviolet light exposure

C. Plummer-Vinson syndrome

D. Reflux esophagitis

Answer: D

Human papillomavirus (HPV) is an epitheliotropic virus that has been detected to various degrees within samples of oral cavity squamous cell carcinoma. Infection alone is not considered sufficient for malignant conversion; however, results of multiple studies suggest a role of HPV in a subset of head and neck squamous cell carcinoma. Multiple reports reflect that up to 40 to 60% of current diagnoses of tonsillar carcinoma demonstrate evidence of HPV types 16 or 18. Environmental ultraviolet light exposure has been associated with the development of lip cancer. The projection of the lower lip, as it relates to this solar exposure, has been used to explain why the majority of squamous cell carcinomas arise along the vermilion border of the lower lip. In addition, pipe smoking also has been associated with the development of lip carcinoma. Factors such as mechanical irritation, thermal injury, and chemical exposure have been described as an explanation for this finding. Other entities associated with oral ...

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