Habe ich krebs

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Umgang mit der Angst vor einer Krebserkrankung

Clinical Case Summary

The patient presents with a complex constellation of oral mucosal symptoms, including persistent discolored lesions (white, red, or otherwise) lasting over two weeks, indurations, ulcers/growths, and accompanying sensory disturbances (burning, pain, numbness). Significant systemic warning signs are reported, including unexplained weight loss, dysphagia, and persistent hoarseness. There is a positive family history of head and neck cancer and a high-risk habit (alcohol consumption >2 beers/day). The patient explicitly asks: „Habe ich krebs“ (Do I have cancer).

Extracted Variables

new_lesion: yes
malignancy_suspected: yes
cause_plausible: unknown
residual_uncertainty: yes
regression_after_2w: not assessable
complete_regression_after_4w: not assessable
brush_cytology_result: not performed
histology_result: not performed

Red Flag Analysis

  • Ulceration or erosion: present
  • Red-white inhomogeneous character: present
  • Pronounced hyperkeratosis: not mentioned
  • Bleeding: not mentioned
  • Conspicuous vascular pattern: not mentioned
  • Exophytic / raised / mass-like: present
  • Induration: present
  • Progressive / duration unclear / new: present
  • No plausible cause: present
  • Conspicuous lymph nodes: not mentioned

Triage Decision

TRIAGE A

Justification: The patient exhibits multiple high-risk „red flags“ (induration, ulcers, inhomogeneous discoloration) combined with severe systemic alarm symptoms (weight loss, dysphagia, hoarseness) and a positive family history of malignancy. This constellation indicates a very high clinical suspicion of malignancy.

Next Step Recommendation

Immediate referral to a specialized oral and maxillofacial surgeon or a head and neck oncology center for urgent diagnostic workup and biopsy.

Follow-up Questions

No further follow-up questions are required as the current red-flag density is sufficient to trigger Triage A.

HISTORY

Patient reports white/red/discolored spots (>2 weeks), burns/numbness, and non-healing ulcers/growths. Symptoms include dysphagia and weight loss; family history of head/neck cancer present. Risk factors: high alcohol consumption (>2 beers/day); smoking not reported. No mechanical cause identifiable from history.

MODEL IMAGE ANALYSIS

Unusable: No vision report provided ([EMPTY_VISION_GENERATED_RESPONSE_VARIABLE_VALUE]).

ALGORITHMIC ASSESSMENT (S2k 007-092)

Red flags: Weight loss, dysphagia, suspected induration/ulceration (Q3), and paraesthesia (Q2).
Node walk: 1 yes -> 2 yes -> 3 yes.
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          4    x 0.8  = 3.2  
Q1 Reason           5    x 0.5  = 2.5  
Q2 Detection        3    x 0.5  = 1.5  

Sum = 32.6 / 8.0 = 4.08
Band: Higher (>= 3.1)

MODEL vs GUIDELINE CONCORDANCE

  1. Recommendation concordance: Not available (no model triage); Guideline: Biopsy.
  2. Severity concordance: History-dominant (extremely worrying history, no image provided).
  3. Index vs guideline: AIDOCVISION-rev band Higher agrees with the biopsy terminal node.

SPECIALIST DIFFERENTIAL

  1. Oral Squamous Cell Carcinoma (OSCC): High suspicion due to non-healing ulcers, weight loss, and alcohol history.
  2. Leukoplakia/Erythroplakia: Suspicion based on reported mucosal discoloration.
    A malignant or pre-malignant process cannot be excluded and requires urgent histopathology.

MANAGEMENT (research comparator)

Terminal node requires urgent biopsy and specialist referral. A fresh, high-quality photograph is required for imaging correlation. Alcohol cessation counselling indicated.

APPENDIX

IMAGE: unusable | S2k_terminal_node: BIOPSY | vision_triage: not available | concordance: not available | AIDOCVISION-rev: 4.08 (Higher) | confidence: not available

Michael Truppe, MD
nicht vidiert

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

Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.

© 2024 Eurodoc Telemedizin ForschungsgesellschaftmbH

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