From the Guidelines
For a 79-year-old underweight female with a history of cancer presenting with tongue lesions, I strongly recommend a comprehensive laboratory workup and a targeted physical examination to rule out malignancy and other potential causes. The patient's history of cancer and underweight condition increase her risk for recurrent or new malignancy, nutritional deficiencies, opportunistic infections, and medication side effects. Given the potential for oral cancer, particularly squamous cell carcinoma, a biopsy of the lesions is crucial for early diagnosis and treatment. The laboratory workup should include:
- Complete blood count (CBC) with differential
- Comprehensive metabolic panel (CMP)
- Vitamin B12, folate, iron studies (serum iron, ferritin, TIBC)
- Hemoglobin A1c
- HSV culture or PCR of the lesions
- Fungal culture
- Autoimmune markers such as ANA and SS-A/SS-B antibodies
- Tumor markers relevant to her specific cancer type
- Nutritional status assessment with prealbumin, albumin, and vitamin D levels due to her underweight condition 1. A targeted physical examination, including visualizing the mucosa of the larynx, base of tongue, and pharynx, is also essential to evaluate the patient's risk for malignancy 1. Early diagnosis and treatment of oral malignancies can significantly improve outcomes, and a comprehensive approach is necessary to address the patient's complex medical history and presentation.
From the Research
Recommended Labs for Lesions of the Tongue
Given the patient's history of cancer and presentation with lesions of the tongue, the following labs are recommended:
- Complete blood count (CBC) 2
- Basic metabolic panel (BMP) 2
- Liver function tests (LFTs) 2
- Thyroid function tests (TFTs) 2
- C-reactive protein (CRP) level 2
- Erythrocyte sedimentation rate (ESR) 2
- Lactate dehydrogenase (LDH) measurement 2
- Ferritin level 2
- Protein electrophoresis 2
- Urinalysis 2
Diagnostic Procedures
Fine-needle aspiration (FNA) may be considered as a diagnostic procedure for lesions of the tongue, especially in patients with a history of cancer 3, 4. FNA has been shown to have high diagnostic accuracy and sensitivity in detecting malignant lesions, especially when compared to other diagnostic modalities such as positron emission tomography-computed tomography (PET-CT) 5.
Considerations for Underweight Patients
In underweight patients, such as the 79-year-old female in question, it is essential to consider the potential impact of malnutrition on laboratory results and overall health outcomes 2. Dietary modifications and nutritional support may be necessary to ensure optimal health and well-being.
Biopsy Techniques
Core needle biopsy (CNB) may be considered as a diagnostic procedure for lesions of the tongue, especially in patients with suspected soft-tissue sarcomas 6. CNB has been shown to have high diagnostic accuracy and sensitivity in detecting malignant lesions, with fewer complications compared to incisional biopsy (IB) 6. However, FNA may be a suitable alternative to CNB for tumor molecular profiling in precision oncology 4.