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CONSENSUS DIAGNOSIS: OSCC
CONSENSUS CIMDL PROBABILITY (0–1, two decimals): 0.07
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 and align on decisive positives (Q7/Q8) with no CIMDL features (Q1, Q3–Q6 negative); probabilities averaged.
– Strong malignancy signal warrants urgent tissue diagnosis and staging.
– Arrange same-week incisional biopsy of the ulcer and ultrasound-guided FNA of the neck node, with contrast-enhanced CT/MRI neck and CT chest in parallel.
– Escalate sooner if airway symptoms, significant bleeding, or rapidly enlarging mass.
– Avoid empiric steroids/antibiotics unless clear infection; manage anticoagulants per protocol.
Given a persistent, indurated mouth ulcer with weight loss and a neck lump, oral cancer is much more likely than other causes; this pattern is considered high risk and should be treated as cancer until proven otherwise. Yes—you need an urgent biopsy and imaging. Safest fast-track sequence we can arrange remotely: today, confirm meds (especially blood thinners), bleeding history, allergies, pain/swallowing/airway status, and duration. Book an urgent ENT/OMFS visit within 72 hours for an in-person exam and incisional biopsy of the ulcer (sample the firm edge, not full excision). In parallel, schedule a same-day/next-day neck ultrasound with FNA of the lump and order contrast-enhanced CT neck (skull base to thoracic inlet) plus CT chest; add MRI face/oral cavity if tongue/floor-of-mouth involvement or nerve-type pain. If any breathing difficulty, uncontrolled bleeding, inability to swallow liquids, or rapidly growing neck mass occurs, go to the ER immediately. I can help coordinate referrals and imaging now so nothing delays tissue diagnosis.
DIAGNOSIS: OSCC
CIMDL PROBABILITY (0–1, two decimals): 0.05
ITEMS (Q1–Q10):
Q1: Negative — “No food or drink comes back through my nose.”
Q2: Negative — “I don’t sound nasal.”
Q3: Negative — “Breathing through my nose is normal.”
Q4: Negative — “No persistent nasal crusting or foul smell.”
Q5: Negative — “No frequent nosebleeds.”
Q6: Negative — “My sense of smell is fine.”
Q7: Positive — “There’s deep, constant mouth pain… sometimes shoots to my ear.”
Q8: Positive — “Persistent mouth ulcer with raised, firm edges that bleeds.”
Q9: Negative — “No major prior treatments… No one suggested immune medications.”
Q10: Positive — “I’ve unintentionally lost weight… a lump in my neck. I smoke or used to, and alcohol has been part of my routine.”
SUMMARY (patient-facing, ≤5 lines):
– What we heard: “persistent mouth ulcer with raised, firm edges” and “weight loss with a neck lump.”
– What this might mean: These features strongly suggest an oral cancer rather than a nasal inflammatory disease.
– Next steps: Arrange urgent in-person evaluation with ENT/head & neck or oral–maxillofacial surgeon; same-week incisional biopsy of the ulcer; ultrasound-guided FNA of the neck lump; contrast-enhanced CT or MRI of face/neck plus CT chest (imaging can be parallel or immediately after biopsy). If pain, bleeding, or swallowing/breathing worsens, go to urgent care/ER.
DIAGNOSIS: OSCC
CIMDL PROBABILITY (0–1, two decimals): 0.08
ITEMS (Q1–Q10):
Q1: Negative — “(no cocaine use mentioned)”
Q2: Negative — “(no autoimmune/vasculitis history mentioned)”
Q3: Negative — “(no septal/palatal perforation mentioned)”
Q4: Negative — “(no saddle‑nose/collapse mentioned)”
Q5: Negative — “(no intranasal crusting/epistaxis mentioned)”
Q6: Negative — “(no midline destructive nasal symptoms mentioned)”
Q7: Negative — “(no tobacco/alcohol risk stated)”
Q8: Positive — “non-healing ulcer… neck lump… weight loss”
Q9: Negative — “(no intranasal decongestant/levamisole exposure mentioned)”
Q10: Positive — “weight loss”
CLINICAL RATIONALE (≤6 lines):
– OSCC red flags cluster: “non-healing ulcer,” “neck lump,” and “weight loss” (Q8 strong, Q10 mild).
– No features suggesting CIMDL (Q1, Q3–Q6 all negative).
– Even without stated classic risks (Q7), symptom pattern strongly favors malignancy.
– Therefore, prioritize urgent tissue diagnosis and staging imaging.
TRIAGE (≤3 lines):
– Urgent in-person head & neck evaluation is indicated.
– Arrange same‑week biopsy and imaging; do not delay tissue diagnosis.
– Escalate sooner (same day) if airway symptoms, bleeding, or rapidly enlarging mass.
AIDOC STEPS (brief, one line each):
1. Safety screen today: meds (anticoagulants), bleeding history, allergies, airway symptoms, duration of ulcer, pain, trismus, dysphagia.
2. Urgent referral (≤72 h) to OMFS/ENT–Head & Neck clinic for exam and biopsy.
3. Imaging orders now: contrast-enhanced CT neck (skull base–thoracic inlet) plus CT chest; add maxillofacial cuts or MRI face/oral cavity if tongue/floor-of-mouth or perineural concern.
4. Tissue diagnosis fast-track: same-day/next-day ultrasound‑guided FNA of the neck lump and incisional biopsy of the ulcer (sample firm edge; avoid complete excision).
5. Pre-procedure labs if indicated: CBC, platelets, INR; manage anticoagulants per protocol; avoid empiric steroids/antibiotics unless clear infection.
6. Symptom care: analgesia, topical rinses (saline/chlorhexidine), soft high‑calorie diet; avoid irritants (alcohol-based mouthwash, hot/spicy foods).
7. Risk counseling: immediate tobacco/alcohol cessation if applicable; nutrition referral for weight loss.
8. Post‑results: multidisciplinary tumor board to stage (AJCC) and plan definitive therapy (surgery ± neck dissection ± adjuvant RT/CT).
9. Follow-up cadence: 48–72 h to confirm tests booked, 7–10 days to review pathology/imaging, then schedule definitive management.
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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