The two-week rule is sound: remove the obvious cause, review in a fortnight, and refer anything that has not resolved. It works because most oral ulceration is traumatic and most traumatic ulceration heals quickly once the cause has gone. It fails when it is applied to findings that were never going to resolve in a fortnight and where the fortnight costs something.
Refer now, not in two weeks
- Erythroplakia. Any velvety red patch that cannot be scraped off and has no other explanation carries the highest rate of dysplasia or carcinoma of any oral mucosal presentation.
- Non-homogeneous or speckled leukoplakia, particularly on the ventral tongue or floor of mouth.
- Any lesion that is indurated on palpation. Firmness in the surrounding tissue is the finding that most reliably separates a serious lesion from an unremarkable one.
- An ulcer with a rolled, everted margin, or one that bleeds on light contact.
- Unexplained tooth mobility with a normal periodontal picture.
- Altered sensation of the lower lip or chin with no dental cause — the numb chin sign. This is a red flag for malignancy until proven otherwise.
- A persistent unexplained neck node.
How to get one seen quickly
Call the direct line rather than sending a form. We hold assessment slots each week for exactly this and they are frequently unused. A ten-second phone call moves a patient from a routine queue into one of them.
If you biopsy in practice
- Take a representative area including a margin of normal tissue, avoiding the necrotic centre of an ulcer.
- Orientate the specimen with a suture if margin reporting matters, and say so on the form.
- Ten per cent neutral buffered formalin, at least ten times the specimen volume.
- Write a clinical description, a differential and the site in millimetres on the request form. "Lesion, mouth" makes the pathologist guess.
- Send us the report if it is unexpected, with the block reference, and we will take it from there.