Post Views: 9

Umgang mit der Sorge vor einer Krebserkrankung

Clinical Assessment and Triage

Case Summary
The patient presents with a solitary ulcer on the lateral border of the tongue. While the visual morphology (small, shallow, yellowish-white base with an erythematous halo) is highly suggestive of a benign aphthous ulcer, the clinical context is highly concerning. The patient reports that the lesion has persisted for more than 2 weeks, mentions „hard nodules“ (induration) and „growth,“ and has a significant risk profile including betel nut use, a positive family history of head and neck cancer, and systemic „red flag“ symptoms (unexplained weight loss, dysphagia, and hoarseness). The patient specifically asks „krebs ?“ (cancer?).

Extracted Variables
– new_lesion: yes
– malignancy_suspected: yes (based on systemic symptoms and high-risk habits)
– cause_plausible: unknown (no specific mechanical irritant identified)
– residual_uncertainty: yes
– regression_after_2w: no (patient reports duration > 2 weeks)
– complete_regression_after_4w: unknown
– brush_cytology_result: not performed
– histology_result: not performed

Red Flag Analysis
– ulceration or erosion: present
– red-white inhomogeneous: not mentioned
– pronounced hyperkeratosis: not mentioned
– bleeding: not mentioned
– conspicuous vascular pattern: not mentioned
– exophytic / raised / mass-like: present (reported as „Wucherungen“ / growths)
– induration: present (reported as „derbe Verhärtungen“)
– progressive / duration unclear / new: present (persisting > 2 weeks)
– no plausible cause: present
– conspicuous lymph nodes: not mentioned

Triage Level
Level A: suspicion of malignancy / malignant lesion

Justification: Although the image alone suggests a benign ulcer, the combination of a high-risk anatomical site (lateral tongue), high-risk habits (betel nut), reported induration, persistence beyond 14 days, and severe systemic symptoms (weight loss, hoarseness, dysphagia) necessitates the highest triage level. The clinical presentation outweighs the visual morphology.

Next Step and Recommendation
Immediate referral to a specialist in Oral and Maxillofacial Surgery or an ENT clinic for urgent biopsy and comprehensive staging. Given the systemic symptoms, this should occur within 1 week.

Follow-up Queries
1. Are there any palpable enlarged lymph nodes in the neck? (yes/no)
2. Has there been a documented increase in the size of the lesion over the last 2 weeks? (yes/no)
3. Is the lesion fixed to the underlying deeper tissues upon palpation? (yes/no)

Parsing gaps: No vision report provided (${VISION_OUTPUT} is empty/missing).

HISTORY

Patient reports white/red spots (>2 weeks), burning, pain, and non-healing ulcers/growths. Reports betel nut use, family history of head/neck cancer, and systemic symptoms (weight loss, dysphagia, hoarseness). No mechanical cause identified from history.

MODEL IMAGE ANALYSIS

IMAGE: not available. No vision report provided for analysis.

ALGORITHMIC ASSESSMENT (S2k 007-092)

Red flags: Weight loss, dysphagia, hoarseness, non-healing ulceration, burning.
Node walk: 1 yes → 2 yes → 3 yes (Clinical suspicion of malignancy based on red flags and history).
Governing terminal node: BIOPSY (Node B).

AIDOCVISION-REV INDEX

## AIDOCVISION-rev  
Item              Score  Weight  Product  
Q3 Duration         5    x 1.5  = 7.5  
Q4 Course           5    x 1.5  = 7.5  
Q5 Symptoms         5    x 1.2  = 6.0  
Q6 Bleeding         3    x 1.2  = 3.6  
Q7 Smoking          1    x 0.8  = 0.8  
Q8 Alcohol          1    x 0.8  = 0.8  
Q1 Reason           5    x 0.5  = 2.5  
Q2 Detection        3    x 0.5  = 1.5  

Sum = 30.2 / 8.0 = 3.78
Band: Higher (>= 3.1)

MODEL vs GUIDELINE CONCORDANCE

Recommendation concordance: Model absent vs Biopsy; guideline more aggressive (divergence: missing data).
Severity concordance: History-dominant (severe history, no image); divergent.
Index vs guideline: AIDOCVISION-rev band Higher agrees with the biopsy terminal node.

SPECIALIST DIFFERENTIAL

Oral Squamous Cell Carcinoma (OSCC): Strongly suspected due to betel nut use, non-healing ulcer, and systemic red flags.
Oral Submucous Fibrosis (OSF) / Leukoplakia: Likely given areca nut exposure; often a precursor to malignancy.
A malignant process cannot be excluded and requires urgent histopathology.

MANAGEMENT

Immediate referral for biopsy and staging (CT/MRI) due to systemic symptoms. Mandatory betel nut cessation counselling. Fresh high-resolution photographs required for baseline documentation.

APPENDIX

Dr. Adegbayi Adeola ADEKUNLE BChD, MSc, FAOCMF, FMCDS, FWACS
Surgeon / Lecturer, Oral and Maxillofacial Surgery
Lagos University Teaching Hospital / College of Medicine, University of Lagos
+234(0)8169608377 / +234(0)8146272414

Research record under a model-vs-guideline concordance protocol

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66
Email ordination@smile.wien

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