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CONSENSUS DIAGNOSIS: OSCC
CONSENSUS CIMDL PROBABILITY (0–1, two decimals): 0.09
MERGED ITEMS (Q1–Q10):
Q1: Negative
Q2: Negative
Q3: Negative
Q4: Negative
Q5: Negative
Q6: Negative
Q7: Positive
Q8: Positive
Q9: Negative
Q10: Positive
ADJUDICATOR NOTE (≤5 lines):
– Both summaries diagnose OSCC with low CIMDL probabilities; we averaged them (0.09) and merged decisive positives (Q7 neck lump, Q8 non-healing ulcer; Q10 weight loss).
– This pattern is far more consistent with oral cancer than CIMDL; proceed with urgent tissue diagnosis and staging.
Given a non-healing oral ulcer with weight loss and a neck lump, oral cancer is very likely and should be treated as the leading diagnosis; other causes exist but are less probable. Yes, you need an urgent biopsy and imaging: best sequence is safety check now (any breathing difficulty, brisk bleeding, inability to swallow liquids, or rapid swelling → go to ER), then within 24–72 hours arrange a head-and-neck clinic visit for exam and flexible scope, same-day ultrasound-guided FNA of the neck node and/or incisional biopsy of the ulcer, and contrast-enhanced CT of the neck plus chest (add MRI of the oral cavity if bone or nerve involvement is suspected). We can request these in parallel to move quickly and ask for expedited pathology; meanwhile, stop smoking, maintain hydration and high-calorie/protein intake, and use saline/baking-soda rinses and pain control as needed. I know this is stressful—acting now gives you the best chance for a clear diagnosis and timely, effective treatment.
DIAGNOSIS: OSCC
CIMDL PROBABILITY (0–1, two decimals): 0.08
ITEMS (Q1–Q10):
Q1: Negative — “(not reported)”
Q2: Negative — “(not reported)”
Q3: Negative — “(not reported)”
Q4: Negative — “(not reported)”
Q5: Negative — “(not reported)”
Q6: Negative — “(not reported)”
Q7: Negative — “(no deep mouth pain or ear pain reported)”
Q8: Positive — “non-healing ulcer”
Q9: Negative — “(not reported)”
Q10: Positive — “weight loss and a neck lump; I smoke 30 cigarettes/day”
SUMMARY (patient-facing, ≤5 lines):
– We heard: “non-healing ulcer,” “neck lump,” “weight loss,” and “I smoke ~30 cigarettes/day.”
– These raise strong concern for oral cancer rather than cocaine-related midline disease; this needs urgent in-person assessment.
– Next steps: urgent ENT/head & neck cancer clinic within days; same-day ultrasound-guided FNA of the neck lump and/or incisional biopsy of the ulcer; contrast-enhanced CT neck plus chest (or MRI for oral cavity) arranged in parallel; stop smoking and maintain nutrition/hydration; seek urgent care if rapid swelling, bleeding, breathing trouble, or dehydration.
DIAGNOSIS: OSCC
CIMDL PROBABILITY (0–1, two decimals): 0.10
ITEMS (Q1–Q10):
Q1: Negative — “not reported”
Q2: Negative — “not reported”
Q3: Negative — “not reported”
Q4: Negative — “not reported”
Q5: Negative — “not reported”
Q6: Negative — “not reported”
Q7: Positive — “neck lump”
Q8: Positive — “non-healing ulcer”
Q9: Negative — “not reported”
Q10: Positive — “weight loss”
CLINICAL RATIONALE (≤6 lines):
– Strong OSCC signals: “non-healing ulcer” (Q8), “neck lump” (Q7), “weight loss” (Q10).
– No CIMDL hallmarks reported (no intranasal cocaine exposure, no septal/palatal perforation, no saddle-nose, no midline necrosis).
– Therefore CIMDL probability low; urgent work-up for oral cancer warranted.
TRIAGE (≤3 lines):
– Urgent in-person head-and-neck exam within 24–72 hours.
– Same-day/next-day tissue diagnosis and staging imaging; escalate to ER now if airway compromise, brisk bleeding, inability to swallow liquids, or rapidly enlarging swelling.
AIDOC STEPS (brief, one line each):
1. Safety check now: any dyspnea, bleeding, dehydration, severe trismus → ER.
2. Arrange urgent clinic visit for focused oral exam and flexible nasoendoscopy.
3. Obtain tissue diagnosis: incisional biopsy of the ulcer under local anesthesia.
4. Sample neck node: ultrasound-guided FNA/core of the “neck lump.”
5. Imaging for staging: contrast-enhanced CT neck (including oral cavity) and chest; add MRI if perineural/mandibular/maxillary invasion suspected.
6. Baseline labs and nutrition: CBC, CMP; start high-calorie/protein supplements; manage pain and oral hygiene.
7. Risk-factor counseling and supportive care: stop tobacco/alcohol; salt/baking-soda rinses; topical analgesia.
8. Fast-track pathology and MDT: request expedited read; tumor board review within 1 week of results.
9. Plan definitive management per staging: surgery ± neck dissection and adjuvant RT/CRT; dental/airway prehabilitation as needed.
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.
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