Patients With Suspicious Lesions

A few months ago a general dentist called my office to get my advice. The dentist had noticed a lesion, which had persisted for several months. The dentist wanted to know how long should a suspicious lesion be “watched” before a biopsy was indicated as well as what are the indications for a biopsy.

The answer to the second question, “What are the indications for a biopsy” is as follows:

Any persistent pathologic condition which cannot be diagnosed clinically: including

  • Lesions with no identifiable etiology that persist for more than 10-14 days.
  • Any intrabony lesions that appear to be enlarging.

Any lesion which is felt to have malignant or premalignant characteristics including the following:

  • Any lesion which has grown or is growing rapidly for no obvious reason.
  • Red, white or pigmented mucosal lesions for which a cause or diagnosis is not evident.
  • Any lesion that feels firmly attached to or fixed to adjacent structures.
  • Any unknown lesion in a high risk area for the development of oral cancer (For example, the floor of the mouth, posterior lateral boarder of the tongue, etc.)

Confirmation of clinical diagnosis suspicions.

Any lesion which doesn’t respond to routine clinical management, such as antibiotic treatment or endodontic treatment over a reasonable period.

Any lesion, which is a source of extreme concern to the patient (that is cancerphobia). The patient’s fear about a persistent lesion may be of greater than the concern about undergoing a minor surgical procedure.

If a lesion has not resolved or changed with in 7-14 days, the dentist must decide whether further observation or biopsy is most appropriate. For lesions with a low index of suspicion, a preliminary diagnosis should be recorded and a photo of the lesion obtained. In general, patients should be re-evaluated at 1, 3, 6, and 12-month intervals. If a biopsy is negative but clinical suspicions remain high, the biopsy report should always be interpreted with the clinical impression in mind and a repeat biopsy may be appropriate. If unsure as to how to proceed, the dentist should obtain a specialist’s opinion.
 

When dealing with suspicious but not frankly malignant or premalignant lesions, close follow-up, detailed documentation, and timely referrals are essential.

Jerry

P.S. I am pleased to be on the program at the Yankee Dental Congress this year as part of the Minuteman series. My topic is Impacted Teeth: Diagnosis & Treatment. I hope to see you at Y.D.C.