What is the workup for a tongue growth (macroglossia)?

From the Guidelines

The workup for tongue growth should begin with a thorough history and physical examination, including a complete head and neck exam, as recommended by the most recent guidelines 1. This initial assessment is crucial for identifying potential risk factors, such as tobacco or alcohol use, and for characterizing the lesion in terms of size, color, texture, and location. The physical examination should include inspection of the face, scalp, and oral cavity, with particular attention to the tongue, tonsils, and pharynx, as outlined in the clinical practice guideline for evaluation of the neck mass in adults 1. Direct visualization and palpation of the lesion are essential, and the use of a tongue depressor and mirror can facilitate examination of the oropharynx. Imaging studies, such as CT or MRI with contrast, may be necessary to evaluate the extent of the lesion and involvement of surrounding structures, as suggested by the NCCN guidelines for head and neck cancers 1. A biopsy, either incisional or excisional, is the most important diagnostic step to determine if the growth is benign or malignant, and fine-needle aspiration (FNA) may be considered for patients with a neck mass deemed at increased risk for malignancy 1. Additional specialized tests, such as endoscopy or PET scans, may be indicated in certain cases, and a multidisciplinary consultation may be necessary to ensure comprehensive care. By following this approach, clinicians can ensure accurate diagnosis and appropriate treatment planning for tongue growths, which can range from benign conditions to malignancies requiring prompt intervention. Key considerations in the workup include:

• Thorough history and physical examination
• Imaging studies, such as CT or MRI with contrast
• Biopsy, either incisional or excisional
• Fine-needle aspiration (FNA) for patients with a neck mass deemed at increased risk for malignancy
• Additional specialized tests, such as endoscopy or PET scans, as indicated
• Multidisciplinary consultation for comprehensive care.

From the Research

Tongue Growth Workup

• A thorough history, including onset and duration, antecedent symptoms, and tobacco and alcohol use, is essential for the diagnosis of tongue growths 2
• Examination of tongue morphology and a careful assessment for lymphadenopathy are also important in the workup of tongue growths 2
• Tongue growths usually require biopsy to differentiate benign lesions from premalignant leukoplakia or squamous cell carcinoma 2
• The role of imaging in the diagnosis of tongue growths is not well established, but ultrasound may be useful in the diagnosis of soft tissue tumors, including those of the tongue 3
• However, when the appearances of the lesion are not typical for a benign lesion, or when malignancy is suspected clinically, further imaging such as MRI and biopsy may be needed 3

Biopsy and Diagnosis

• Biopsy is essential for the diagnosis of tongue growths, as it can help differentiate between benign and malignant lesions 2
• The management of suspicious tongue growths should be carefully planned by a multidisciplinary team involving specialized surgeons and pathologists 3
• The diagnosis of tongue growths can be challenging, and a careful consideration of the patient's history, clinical examination, and imaging findings is necessary to establish an accurate diagnosis 4

Treatment and Management

• The treatment of tongue growths depends on the diagnosis, and may include topical antifungals, oral antivirals, or surgical excision 2
• In some cases, tongue growths may not require treatment, such as geographic tongue, fissured tongue, and hairy tongue 2
• However, tongue growths that are suspicious for malignancy should be biopsied and managed accordingly 2