From the Guidelines
For a tongue lesion, I strongly recommend prompt referral to an oral medicine specialist, oral surgeon, or otolaryngologist (ENT) for proper evaluation and management, as early diagnosis is crucial for potentially serious conditions like oral cancer. The referral should be made within 2-3 weeks for most lesions, but urgent referral (within 1-2 weeks) is necessary for lesions that are painful, rapidly growing, ulcerated, or have been present for more than 2 weeks without improvement. According to the clinical practice guideline for evaluation of the neck mass in adults 1, a targeted physical examination, including visualizing the mucosa of the larynx, base of tongue, and pharynx, is recommended for patients with a neck mass deemed at increased risk for malignancy.
When making the referral, include detailed information about the lesion's appearance, duration, associated symptoms, and any risk factors such as tobacco or alcohol use. Tongue lesions can range from benign conditions like geographic tongue or trauma-related ulcers to potentially serious conditions like oral cancer. The specialist will likely perform a thorough examination, which may include inspection of the oral cavity, oropharynx, and palpation of the oral tongue, base of tongue, and tonsils, as outlined in the clinical practice guideline 1.
While waiting for the appointment, advise the patient to avoid irritants like spicy foods, alcohol, and tobacco products, and to maintain good oral hygiene. Early diagnosis is crucial, especially for malignant lesions, as delayed diagnosis can significantly impact treatment outcomes and survival rates. The specialist may recommend a biopsy to determine the exact nature of the lesion, and a thorough examination can help identify suspicious signs, such as tonsil asymmetry or mass, or ulcer in any location.
Key considerations for the referral include:
- Lesion appearance and duration
- Associated symptoms, such as pain or difficulty swallowing
- Risk factors, such as tobacco or alcohol use
- Urgency of the referral, based on the lesion's characteristics and the patient's overall health. The clinical practice guideline 1 emphasizes the importance of a targeted physical examination, and the need for referral to a specialist if the examination is incomplete or suspicious for malignancy.
From the Research
Referral Service for Tongue Lesion
- Tongue lesions of unclear etiology may require biopsy or referral to an oral and maxillofacial surgeon, head and neck surgeon, or a dentist experienced in oral pathology 2
- The diagnosis and treatment of tongue lesions can be complex and may involve various medical specialties, including oral and maxillofacial surgery, head and neck surgery, and dentistry
Imaging Modalities for Tongue Lesions
- Computed tomography (CT) and magnetic resonance imaging (MRI) are valuable tools for assessing tongue lesions, with MRI being superior for displaying soft tissues and tumor extent 3
- MRI is the preferred modality for evaluating and staging oral cavity malignancy, including tongue lesions, and helps clinicians plan treatment 4
- Intraoral ultrasonography (US) is also an accurate preoperative diagnostic tool for T1 and T2 squamous cell carcinoma of the tongue, with less overestimation of depth of invasion compared to CT and MRI 5
Role of MRI in Evaluating Tongue Carcinoma
- MRI provides accurate information regarding the extent of the lesion and depth of invasion, which helps clinicians optimize treatment strategy 6
- MRI is the imaging modality of choice for evaluation of tongue carcinoma, with a high correlation between MRI and histopathological findings regarding tumor thickness and depth of invasion 6
- Estimation of invasion depth using MRI as a preoperative study in oral tongue carcinoma is essential in planning surgical treatment strategies, such as the extent of elective neck dissection 6