Dear Mr. Freud,
Your case presents with a leukoplakic lesion on the jaw and palate, which has been a subject of concern since its initial appearance in late 1917. The recurrence of symptoms and the current diagnosis by Dr. Felix Deutsch suggest a need for a thorough evaluation.
Leukoplakia is a white patch that can occur in the oral cavity and is considered a potentially malignant disorder. The fact that the lesion receded previously upon resuming smoking may have been coincidental, as there is no scientific evidence to suggest that smoking cessation would exacerbate such a condition. On the contrary, tobacco use is a well-established risk factor for the development of oral leukoplakia and malignancies.
Given the history of heavy cigar smoking and the appearance of the lesion, it is prudent to consider the possibility of an oral squamous cell carcinoma. It is not uncommon for patients and even clinicians to avoid using the term “cancer” due to its psychological impact, but it is essential for an accurate diagnosis and appropriate treatment plan.
The recommendation to cease smoking is sound advice, as continued tobacco use can exacerbate the lesion and increase the risk of malignant transformation. As an oral and maxillofacial surgeon, I would advise a biopsy of the lesion to obtain a definitive diagnosis. This would involve the surgical removal of a small section of the affected tissue, which would then be examined microscopically.
If the biopsy confirms a diagnosis of epithelioma, or squamous cell carcinoma, several treatment options are available. The primary treatment for oral cancer is surgical excision, which involves removing the cancerous tissue along with a margin of healthy tissue to ensure complete removal. Depending on the extent of the lesion, this may be followed by reconstructive surgery to restore function and appearance.
Radiation therapy and chemotherapy are additional treatment modalities that may be considered, either alone or in combination with surgery, depending on the stage and aggressiveness of the cancer.
It is also important to address any other health concerns, such as heart and respiratory problems, as these can impact treatment decisions and overall prognosis.
In summary, I strongly recommend a biopsy to establish a definitive diagnosis. Should the lesion be malignant, a multidisciplinary approach involving surgery, and possibly radiation and chemotherapy, will be necessary. Cessation of smoking is crucial in any case to improve treatment outcomes and reduce the risk of recurrence.
Please feel free to consult further for a detailed discussion of the treatment options and to address any other concerns you may have.
Sincerely,
Prof. R. E.
Oral and Maxillofacial Surgeon
2024-01-30 20:50 Telekonsultation
Dear Professor Freud,
Your recent experience with a painful swelling in the soft palate and the subsequent leukoplastic growth on your jaw and palate are indeed concerning. The fact that the swelling receded after resuming smoking may have been coincidental, and it is prudent to investigate further, especially given the appearance of leukoplakia, which can be a precursor to more serious conditions.
The opinion of Dr. Felix Deutsch, suggesting “bad leukoplakia” rather than epithelioma, offers some reassurance. However, leukoplakia can indeed be a risk factor for malignant transformation, particularly in the context of significant tobacco use, as in your case. It is important to note that the absence of the term “cancer” in discussions does not preclude the necessity for a thorough diagnostic workup.
As a maxillofacial surgeon, I would recommend an excisional biopsy of the lesion to obtain a definitive diagnosis. This procedure involves removing the growth and a small margin of surrounding tissue, which can then be examined histologically. The results will guide us in determining the appropriate course of action.
Given the advancements in medical knowledge and technology by 2024, alternative treatments and diagnostic tools would likely be available. For instance, we would consider the use of non-invasive imaging techniques such as MRI or PET scans to assess the extent of the lesion. Additionally, advancements in molecular pathology might allow for a more precise characterization of the lesion at a genetic level, potentially identifying targeted therapies.
Should the biopsy confirm a malignant process, treatment options would include surgical resection, possibly followed by radiotherapy or chemotherapy. In 2024, we might also consider immunotherapy or molecularly targeted therapies, which have shown promise in treating various types of cancers by harnessing the body’s immune system or targeting specific genetic mutations.
It is imperative to consider cessation of smoking, as continued tobacco use could exacerbate the condition and hinder treatment efficacy. Smoking cessation support, which has evolved significantly, would be highly recommended.
In summary, while the recommendation to consult a rhinologist for excision of the growth is sound, it is crucial to proceed with a biopsy to establish a clear diagnosis. Should you require surgical intervention, rest assured that the field of maxillofacial surgery has made considerable strides in both operative techniques and prosthetic rehabilitation, aiming to preserve function and aesthetics to the greatest extent possible.
Please feel free to reach out for further consultation or clarification on any of the points discussed.
Sincerely,
Hans Pichler (1877 – 1949)
Head of the Maxillofacial Surgery Department
First Surgical University Clinic
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
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