it is now 3 years past first surgery. how likely is it that I have a recidiv, I have again a bleeding ulcer on the soft palate

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Structured Evaluation of the Medical Teleconsultation Transcript

1. Transparency & Explainability:
   • The consultation provides a detailed explanation of the clinical reasoning behind the recommendations, focusing on the patient’s history and symptoms. This aligns with transparency requirements.
   • The transcript does not explicitly inform the patient that AI is used in the diagnosis, treatment, or recommendations, which is a key requirement under the EU AI Act for transparency and informed consent.
2. Privacy & Data Protection (GDPR Compliance):
   • The transcript does not provide information on how personal health data is processed, nor does it mention compliance with GDPR or the EU AI Act. There is no evidence of data minimization or anonymization techniques being applied.
   • There is no mention of informing the patient about their data rights, including access, correction, and deletion, which is mandatory under GDPR.
3. Risk Management & Safety Compliance:
   • The consultation seems to adhere to some extent to safety and risk management standards, as it aligns its diagnosis with medical best practices and clinical guidelines for OSCC.
   • There are no indications in the transcript of misleading, unsafe, or incorrect medical advice, but this could be enhanced with explicit safety measures and risk management plans.
4. Accountability & Human Oversight:
   • There is no mention of documentation on AI decision-making, including audit logs, which are crucial for accountability.
   • The transcript does not demonstrate adequate human oversight or intervention, nor does it describe escalation mechanisms for contested or uncertain AI recommendations.
5. Ethical Considerations & Patient Trust:
   • The system does not explicitly respect patient autonomy and informed consent, particularly regarding the use of AI.
   • While the recommendations are aligned with ethical medical practices, there is no evidence of human verification, suggesting an undue reliance on AI without sufficient human oversight.

Final Evaluation:
Overall Compliance Rating: 2 (Partially Compliant)

Critical Gaps & Recommendations for Improvement:
– Clearly inform the patient about the use of AI in their diagnosis and treatment recommendations to enhance transparency.
– Ensure compliance with GDPR by implementing data protection measures, including data minimization, anonymization, and informing patients of their data rights.
– Provide documentation of AI decision-making processes and ensure that proper audit logs are maintained.
– Establish human oversight mechanisms and escalation procedures for AI recommendations that are contested or uncertain.
– Reinforce ethical considerations by ensuring informed consent and reducing reliance on AI without adequate human verification.

Addressing these gaps will help achieve full compliance with the EU AI Act.

I’m sorry to hear that you’re experiencing a bleeding ulcer on your soft palate, especially after having surgery three years ago. It’s understandable to feel concerned about the possibility of recurrence. Let’s go through the steps to address your situation thoroughly and compassionately.

1. Full Oral Examination

First, let’s ensure a complete oral mucosal examination has been conducted. This is important to identify any new changes or lesions that might not have been apparent before. If this hasn’t been done yet, we should arrange for it promptly.

2. Malignancy Suspicion

During the examination, we need to assess whether there are any signs that might suggest the presence of a malignancy, such as the non-healing nature of the ulcer, its appearance, or any induration (hardening). Your symptom of a bleeding ulcer could raise suspicion and warrant further investigation.

• If there is a clinical suspicion of malignancy based on these features, the next appropriate step is to perform a biopsy to obtain a definitive diagnosis.

3. Identify Underlying Causes

If no immediate suspicion of malignancy arises, it’s crucial to consider other potential causes for the ulcer:
– Mechanical causes: such as trauma from dental appliances or ill-fitting dentures.
– Functional causes: like repeated irritation from certain habits.
– Systemic causes: including conditions that affect overall health and healing.

If any such cause is identified, addressing it might resolve the ulcer.

• If the lesion completely resolves after addressing the underlying cause, regular follow-up should be scheduled to monitor for any new changes.

4. Further Diagnostic Steps

In the absence of an identified cause, or if there’s still a high suspicion of malignancy, proceeding with a biopsy is essential. This is a crucial step to understand the nature of the lesion better.

• Sometimes, a two-week observation period or brush cytology (Bürstenzytologie) can be additional steps to gather more information about the lesion if complete certainty is not achieved immediately.

5. Observe Regression

Once the biopsy or other diagnostic measures are done, re-evaluating the lesion after a short follow-up period (about two weeks) is important.

• If it completely regresses, you will continue with regular follow-up care.
• If it persists, the findings from the biopsy or cytology will guide the next steps.

6. Interpret Dysplasia

If the biopsy indicates dysplasia:
– Low-grade dysplasia: Careful observation and consistent follow-up are recommended.
– High-grade dysplasia or more advanced changes: Referral to a specialized care team, such as maxillofacial or head-and-neck oncology specialists, is necessary for comprehensive management.

Additional Considerations

It’s important to consider any additional risk factors you might have, such as smoking, alcohol use, or an immunocompromised state, as they can influence the management approach.

Conclusion and Reassurance

Your health and peace of mind are our top priorities. The process outlined here is designed to ensure that any potential issues are identified and addressed promptly. This stepwise approach helps rule out malignancy or detect it early, providing the best chance for effective management.

Please feel free to share any more concerns or questions you have. We’re here to support you through this process.

AIDOC_Algorithm02022025

Primary Diagnosis: Recurrent Oral Squamous Cell Carcinoma (OSCC)

1. Clinical Reasoning:
   • History of Malignancy: Sigmund Freud has a documented history of oral squamous cell carcinoma with multiple recurrences and surgeries.
   • Symptoms: The presence of a bleeding ulcer on the soft palate is concerning for recurrence. OSCC often presents as non-healing ulcers, especially in previously affected areas.
   • Recurrence: Recurrence is common in oral cancers, particularly with incomplete resection or positive margins, as noted in Freud’s earlier surgical history.
2. Pathophysiological Considerations:
   • Tobacco Use: Freud’s history of heavy cigar smoking is a well-known risk factor for OSCC.
   • Previous Treatment: The complexity and frequent recurrence of the condition suggest ongoing malignant potential.

Differential Diagnoses:

1. Oral Mucosal Trauma:
   • Justification: Mechanical irritation from prosthetic appliances could cause ulcers; however, the persistence and bleeding are more suggestive of malignancy.
2. Radiation-Induced Ulceration:
   • Justification: Past radiotherapy can cause mucosal damage, but recurrent cancer is more likely given the history.
3. Infectious Ulcer (e.g., fungal, bacterial):
   • Justification: Immunocompromised status due to prolonged cancer treatment may predispose to infection, but malignancy recurrence is more consistent with observed symptoms.
4. Necrotic Tissue due to Compromised Blood Supply:
   • Justification: Surgical changes could impair blood supply causing necrosis, yet the malignant history prevails in likelihood.

The primary diagnosis of recurrent OSCC is more plausible due to the characteristic presentation of a bleeding ulcer in a patient with a significant history of oral cancer. The likelihood of recurrence is notably high considering the incomplete previous resections and extensive surgical history.

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Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

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

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