Examination principles and routing
During an outpatient appointment, the dentist performs an initial clinical examination. Depending on the situation, the patient may be referred to an oncologist immediately or after undergoing a biopsy and additional tests.
To assess the extent of tumor spread and search for metastases, targeted imaging is prescribed:
- If pulmonary involvement is suspected — chest radiography.
- To assess the abdominal organs and retroperitoneal lymph nodes — ultrasound examination (US).
- If there is a risk of skeletal involvement — bone radiography.
Before planning surgery under general anesthesia, the patient must undergo a biochemical blood test, an ECG, sanitize the oral cavity, and obtain clearances from related specialists. The nature of the process is confirmed solely histologically; cytological smears are preliminary in nature.
Differential diagnosis
A crucial task for the clinician is to differentiate between a true tumor and a non-tumor pathology, as they often share similar symptoms.
Classic examples for differentiation:
- Chronic lymphadenitis of the neck or retromandibular region must be distinguished from pleomorphic adenoma, lateral neck cyst, and metastatic lymph node involvement.
- Chronic sialadenitis mimics a tumor of the submandibular salivary gland.
- A traumatic ulcer of the mucous membrane or lip is differentiated from a cancerous ulcer.
- Chronic maxillary sinusitis requires ruling out malignant growth in the maxillary sinus.
When diagnosing lesions of the lower lip, it is important to rule out a tuberculous ulcer and syphilis.
Malignant neoplasms of the skin and lip
Carcinomas predominate in the maxillofacial region, whereas sarcomas are much less common. The disease most frequently affects individuals over 40 years of age.
Basal cell carcinoma (ulcus rodens, basalioma) exhibits a locally destructive growth pattern. The disease is typical for elderly individuals and often develops against the background of senile keratomas. The tumor type presents as nodules with a depressed center and dense rolled borders, whereas the ulcerated type is capable of aggressively destroying cartilage and bone tissue.
Squamous cell carcinoma is characterized by rapid infiltrative growth and a tendency for lymphogenic metastasis. It may manifest as a dense ulcer with a crater-like base or papillary proliferations on a broad base.
Lower lip cancer is more frequently diagnosed in men living in rural areas. The endophytic form of the disease (ulcerative or ulcer-infiltrative) is extremely aggressive: a massive dense infiltrate forms, which metastasizes early to the submandibular lymph nodes.
Facial melanoma
Malignant melanoma develops from pigment-producing cells and carries an extremely unfavorable prognosis. The tumor arises on outwardly healthy skin, against the background of precancerous Dubreuilh's melanosis, or upon trauma to a pigmented nevus. The depth of tumor cell penetration into the tissues is assessed according to Clark's five levels of invasion.
Clinically, the lesion appears as a dark spot or nodule with a glossy surface. When melanoma is suspected, it is strictly contraindicated to perform a biopsy, puncture, or scraping of the intact surface, as trauma provokes instantaneous generalization of the process.
The diagnosis is established by total excision of the lesion (with a margin of at least 2–3 cm) under general anesthesia, accompanied by frozen-section (express) histology. A cytological smear is permitted only from a surface that has already spontaneously ulcerated.
Briefly: answers to topical questions
What are Clark's levels of invasion in cutaneous melanoma?
There are 5 stages (levels) of melanoma invasion according to Clark, which reflect the depth of tumor penetration into the skin layers.
- Stage I (melanoma in situ) — melanoma cells are located exclusively in the epidermis.
- Stage II — the tumor penetrates through the basement membrane into the papillary dermis, but does not completely fill or distend it.
- Stage III — the tumor nodule completely fills the papillary dermis and reaches the boundary with the reticular dermis, increasing the layer's volume.
- Stage IV — invasion of tumor cells (melanocytes) into the reticular dermis occurs.
- Stage V — tumor cells invade and reside in the subcutaneous adipose tissue.
Class and exam questions
How to clinically differentiate a tuberculous ulcer of the lip from a cancerous one?
A tuberculous ulcer is superficial, has soft edges, and is sharply painful. A cancerous ulcer is initially painless, characterized by a firm base and raised, rolled borders.
What is the main difference between basalioma and cutaneous squamous cell carcinoma?
Squamous cell carcinoma is distinguished by rapid infiltrative growth and the ability to metastasize early to regional lymph nodes, whereas basalioma exhibits predominantly locally destructive growth.
What does the letter "p" signify in a TNM classification diagnosis?
The addition of the lowercase letter "p" (e.g., pT, pN) indicates a recurrence of a malignant neoplasm following prior surgical treatment.
What else to study on this topic
- The five stages of infiltrative melanoma growth according to W.H. Clark.
- Surgical techniques for removing neck metastases (Crile's operation, fascial-compartment neck dissection).
- Determining the margins of radical excision for basalioma depending on its stage.
- Features of the clinical course of exophytic and endophytic forms of lower lip cancer.
Master the entire topic in the course "Surgical Dentistry"
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Tumor-like diseases of the maxillofacial region" and 866 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 28 video lessons on the subject
Other topics from the section "Chapter 14. Tumors and Tumor-like Lesions of the Maxillofacial Region (V.N. Bogatov, S.N. Lebedev)"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.