Oral leukoplakia: The Daily PANCE Blueprint

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Oral leukoplakia: The Daily PANCE Blueprint

A 67-year-old woman undergoes incisional biopsy of leukoplakia on the ventrolateral tongue concerning for severe dysplasia. Pathology returns as squamous cell carcinoma in situ. She is scheduled for resection in 2 weeks. She continues to smoke 1/2 pack daily. Which of the following is the most urgent management recommendation?

A. Broad spectrum antiviral medication
B. Imaging studies to evaluate involved lymph nodes
C. Supplemental vitamin A 25,000 units daily
D. Surgical excision within 1-2 weeks
E. Strict tobacco cessation immediately

Answer and topic summary

The answer is E) Strict tobacco cessation immediately

The most urgent recommendation for this patient with carcinoma in situ related to smoking is immediate and strict tobacco cessation prior to resection, as continued smoking confers a markedly increased risk of recurrence, second primaries, and malignant conversion even after excision. Resection within 2 weeks is reasonable. Imaging is appropriate for cancer staging only after histological confirmation of invasive squamous cell carcinoma invading the basement membrane rather than carcinoma in situ. Antiviral medication and vitamin A supplementation are not recommended urgent interventions.

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Covered under ⇒ PANCE Blueprint EENT ⇒ Other oropharyngeal disorders (Pearls) ⇒ Oral leukoplakia