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TEASER Summary Evaluation
Purpose & main content
• Gives a snapshot of the likely and “can’t-miss” causes of a red/white lesion under the tongue, then lists key diagnostic and treatment steps, ending with a short “Chapter Answer” written directly to the patient.
• Mixes professional bullet-point material (in German) with a brief patient-facing paragraph.
Scores
Accuracy: 4/5 – Correct description of squamous-cell carcinoma, leukoplakia, biopsy as gold standard, staging imaging, etc.; minor omissions (e.g., HPV as aetiology) and no clear distinction between dysplasia grades.
Completeness: 3/5 – Covers the main dangerous diagnosis, risk factors and work-up but omits several typical early symptoms (sore throat, ear pain, loose teeth, difficulty swallowing) and does not touch on HPV, denture irritation or nutritional factors.
Clarity: 2/5 – Heavy German medical jargon (“Plattenepithelkarzinom”, “Lidocain-Mundspüllösung”, “suprahyoidale Abszesse”), abrupt bulleted style, code-switching EN/DE; only the final paragraph is in plain language.
Actionability: 4/5 – Gives a concrete sequence: urgent specialist referral, biopsy, imaging, pain control, tobacco/alcohol stop. “Was-next” steps are unambiguous.
Tone: 3/5 – Conveys warranted urgency but is somewhat alarming and impersonal until the closing paragraph, which is more reassuring.
MAIN Summary Evaluation
Purpose & main content
• Structured like a specialist clinic note following the S2k guideline; walks through nine diagnostic/management steps, lists advanced imaging and AI tools, ends with a shared-decision summary and reassurance for “Mr Freud.”
Scores
Accuracy: 5/5 – Aligns with current S2k guideline, correctly lists high-risk sites, risk synergies, biopsy technique, imaging indications, depth-of-invasion criteria, HPV testing, etc. No evident medical errors.
Completeness: 5/5 – Covers history, examination, risk factors, full diagnostic algorithm, follow-up, lifestyle counselling. Rarely omits anything relevant to early oral cancer.
Clarity: 2/5 – Dense with technical terms (“field cancerisation”, “TORS”, “Ki-67”, “liquid-based cytology”, “18F-FDG-PET”). Long multi-clause sentences; assumes knowledge of neck levels, ICD-codes. Hard for a lay reader.
Actionability: 4/5 – Very explicit next steps (same-day MRI, biopsy, cessation programme, when to return). The sheer volume, however, may overwhelm a patient.
Tone: 3/5 – Professional, but detached and acronym-laden; brief reassurance paragraph helps but overall may feel intimidating.
Comparison & Overall Effectiveness
• MAIN is superior in Accuracy and Completeness, but its specialist style sharply lowers Clarity and mildly affects Tone.
• TEASER is shorter and slightly more conversational in its final paragraph, so marginally better for lay comprehension, yet still too technical.
• For the intended “patient who is worried about symptoms,” neither version fully meets readability needs, but TEASER edges ahead on approachability, whereas MAIN is the better clinical reference.
Strengths & Weaknesses
TEASER
+ Accurate core message; clear call for urgent biopsy.
+ Brief final paragraph speaks directly to the patient.
– Mixed languages and jargon reduce readability.
– Limited list of early warning signs; no follow-up plan details.
– Tone oscillates between textbook bullets and patient talk.
MAIN
+ Guideline-based, exhaustive and up-to-date.
+ Lays out a complete algorithm and shared-decision steps.
+ Includes risk-factor counselling and when-to-return warnings.
– Overwhelming technical detail; reads like a resident’s note.
– Uses acronyms without explanation; may frighten patients.
– Focuses more on process than on describing warning symptoms.
Recommendations for Improvement
TEASER
1. Replace jargon with plain words: “Plattenepithelkarzinom” → “Mundhöhlenkrebs (Plattenepithel)”.
2. Add a short list of other early signs (non-healing sore, ear pain, difficulty chewing).
3. Keep all patient-facing text together; move professional bullet list to an appendix.
4. Insert concrete time frames: “See a specialist within one week.”
5. Use headings like “Was Sie jetzt tun sollten” to improve navigation.
MAIN
1. Create a condensed patient version: 1-page FAQ with plain language, removing ICD codes and AI tool details.
2. Define or delete acronyms (e.g., explain “MRI”, skip “CBCT”).
3. Highlight key symptoms up front so the patient understands why biopsy is needed.
4. Soften tone: fewer capitalised STEP headers, more empathetic statements.
5. Include readability aids: bullet icons, subheadlines like “Why this matters to you,” “What happens next.”
- Most Likely Differential Diagnoses:
- Plattenepithelkarzinom der Zunge / Mundboden (oral squamous cell carcinoma): Persistierende rote / weiße Läsion >2 Wochen, tastbarer Knoten, leichtes Taubheitsgefühl, Gewichtsverlust, Rauchen + Alkoholkonsum, Familienanamnese für Krebs.
- Leukoplakie / Erythroplakie mit hochgradiger Dysplasie: Gleiche klinische Farbe (weiß/rot) und Lokalisation; wesentliches Risikoprofil. Kann präkanzerös sein oder bereits frühe invasive Veränderungen enthalten.
- Traumatisches chronisches Ulkus oder infektiöse Superinfektion (z. B. Candida): Einzelne Wunde an druckexponierter Stelle, kann weiße Beläge zeigen; jedoch weniger typisch für Taubheit + Gewichtsverlust, daher Platz 3.
- Can’t-Miss Diagnoses:
- Kopf-/Hals-Sarkom, Lymphom oder Fernmetastase: Selten, aber aggressiv; Biopsie muss maligne Zellbilder zweifelsfrei differenzieren.
- Syphilis (Stadium II/III) oder HIV-assoziierte ulzeröse Veränderungen: Systemische Infektionskrankheiten mit Therapiepflicht, v. a. bei Gewichtsverlust.
- Tiefsitzende odontogene bzw. suprahyoidale Abszesse (z. B. beginnendes Ludwig-Angina): Gefahr rascher Atemwegsobstruktion, muss bei ausgeprägter Schwellung ausgeschlossen werden.
- Key Next Diagnostic Steps:
- Dringende Überweisung an HNO- oder Mund-Kiefer-Gesichtschirurgie zur vollständigen Inspektion (Ohr-Nase-Rachen), Palpation aller Schleimhäute und Halslymphknoten. Rationale: klinisches Staging, Suche nach Zweitläsionen.
- Incisions- oder Exzisionsbiopsie der Läsion unter der Zunge. Rationale: histologischer Goldstandard, um Karzinom/Dysplasie sicher zu bestätigen oder auszuschließen.
- Bildgebung (Kontrast-MRT oder CT von Kopf/Hals + ggf. Sonographie der Halsweichteile). Rationale: Tumorausdehnung, Knocheninfiltration und Lymphknotenstatus klären.
- Basislabor inkl. BB, CRP, Leberwerte; bei Verdacht Serologien (HIV, TPHA/VDRL). Rationale: präoperative Planung, Differenzierung infektiös vs. neoplastisch.
- Key Next Treatment Steps:
- Bis zur definitiven Diagnose: lokale Schmerz-/Symptomkontrolle (Lidocain-Mundspüllösung, NSAR), Vermeiden scharfer Speisen / Alkohol / Tabak; antimykotische Mundspülung, falls klinischer Candida-Verdacht.
- Nach Biopsie-Resultat:
• Bei Karzinom: multidisziplinäre Tumorkonferenz → chirurgische Resektion ± Halslymphknotendissektion, Radiotherapie / Chemotherapie je nach Stadium.
• Bei präkanzeröser Dysplasie: vollständige Entfernung (Laser/Chirurgie) + engmaschige Nachsorge.
• Bei infektiösem Ulkus: gezielte Antiinfektiva, Mundhygiene-Optimierung, ggf. Zahn-Sanierung. - Unverzügliche Tabak- und Alkoholkarenz; Beratung zu Rauchstopp-Programmen. Rationale: Prognoseverbesserung, Rezidivschutz.
Chapter Answer:
Sie haben recht, dass die Ursache Ihrer Beschwerden momentan unklar ist. Eine länger bestehende rote oder weiße Stelle unter der Zunge, die sogar etwas knotig wirkt und Taubheitsgefühle auslöst, ist nicht normal und gehört sorgfältig abgeklärt – besonders wenn man raucht, regelmäßig Alkohol trinkt und ungewollt Gewicht verliert. Wir wollen sicherstellen, dass es sich nicht um eine Vorstufe oder bereits um einen bösartigen Tumor der Mundschleimhaut handelt. Deshalb ist der nächste Schritt eine genaue Untersuchung durch einen Mund-, Kiefer-Gesichts- oder HNO-Spezialisten. Dabei wird die gesamte Mundhöhle und der Hals abgetastet und eine kleine Gewebeprobe (Biopsie) aus der betroffenen Stelle entnommen. Nur so lässt sich zweifelsfrei sagen, ob bösartige Zellen vorliegen. Parallel kümmern wir uns um Ihre Schmerzen mit betäubenden Spülungen und entzündungshemmenden Medikamenten. Wichtig ist jetzt außerdem, das Rauchen und den Alkoholkonsum einzustellen, weil beide die Schleimhäute zusätzlich schädigen. Sobald das Biopsie-Ergebnis vorliegt, besprechen wir gemeinsam die beste Therapie, damit Ihre Beschwerden rasch und dauerhaft gelindert werden.
Department of Oral & Maxillofacial Surgery
University Hospital – Medical University Vienna
Patient: Mr Sigmund FREUD (DoB 06-05-1856)
Date: today
Chief complaint (translated):
“I am not sure whether my symptoms stem from toothache, gingival bleeding, my tongue or from a strange wound under the tongue. I hope you can find the cause and relieve my symptoms.”
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AIDOC DIAGNOSTIC-AND-MANAGEMENT FLOW (based on the S2k-guideline “Vorläuferläsionen des oralen Plattenepithelkarzinoms”)
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STEP 1 COMPLETE EXAMINATION OF THE ORAL MUCOSA
• Relevance: A full-mouth inspection including bimanual palpation, mirror and gauze exploration is mandatory in every patient with intra-oral colour change or mass.
• Action plan: Perform naked-eye inspection + adjunctive tools (optical fluorescence/Velscope, contact endoscopy). Document size, colour, fixation, induration, surface, exact topography (right ventrolateral tongue/floor of mouth). Palpate neck levels I–IV.
Correspondence with questionnaire:
Q01, Q07 → patient reports red-white patch under the tongue persisting > 2 weeks.
Q02 → sensory deficit (numbness) supports neuropathic or infiltrative process.
Q03 → “lump” palpated by patient requires confirmation of induration/fixation.
STEP 2 NEW CLINICAL CHANGES IN THE ORAL MUCOSA – PRESENT!
• Guideline consequence: proceed to malignancy assessment; routine recall is insufficient.
STEP 3 CLINICAL SUSPICION OF MALIGNANCY OR MALIGNANT LESION – HIGH SUSPICION
Risk enhancers in this individual
– Field cancerisation site: ventrolateral tongue/floor of mouth = “high-risk anatomic zone”
– Q04 Nicotine (≈10 cigarettes / d) + regular beer (≈2 units/d) → synergistic risk
– Q10 Unexplained weight loss over 6 months = possible systemic tumour effect
– Q02 Numbness (“N” in the mnemonic “C-N-E-U-S”) = neural invasion suspect
– Q05 lack of professional oral cancer screening for years
– Age > 50 y
Conclusion: We consider the lesion at least “potentially malignant”. Move to STEP 4 without delay.
STEP 4 CHECK FOR A RECOGNISABLE CAUSE
• Differential irritants evaluated:
Q04 smoking/alcohol – yes, but they do not explain a focal ulcer & induration.
Q09 no spices/mouth-wash abuse.
Dental sharp cusp / calculus: to be checked clinically; if present, remove and reassess.
Because NO clear reversible mechanical reason is evident, we must proceed to biopsy.
STEP 5 BIOPSY (per guideline)
• Recommended procedure: incisional biopsy, taking the border zone of red/white area including deepest induration. Minimum width 3 mm, depth to submucosa.
• Adjuncts:
– On-site tele-pathology / AI-assisted whole-slide imaging for rapid dysplasia grading.
– Immunohistochemistry p16 (HPV-surrogate marker) & Ki-67.
• Imaging before biopsy: high-resolution intra-oral ultrasound to map thickness; consider MRI with surface coil of tongue/floor to stage depth of invasion (> 5 mm changes neck management).
STEP 6 DYSPLASIA – MANAGEMENT ACCORDING TO GRADE
• Possible outcomes and planned responses:
LOW-GRADE DYSPLASIA → complete excision or 3-month surveillance with digital photo-mapping.
HIGH-GRADE DYSPLASIA / CIS / MICRO-INVASIVE SCC → referral to tumour board, staging (MRI head-neck, contrast-enhanced CT chest, ±18F-FDG-PET), discussion of margin-controlled resection (CO2-laser / TORS) ± sentinel node biopsy.
STEP 7 COMPLETE REGRESSION & NON-SUSPICIOUS CYTOLOGY
If histology shows benign hyperkeratosis AND the lesion fully resolves after eliminating trauma (e.g. smoothening a tooth), patient returns to 6-month recall with photo-documentation.
STEP 8 REMAINING UNCERTAINTY
• Algorithm rule: If biopsy is non-diagnostic or the lesion re-appears → repeat evaluation in 2 weeks with brush cytology (liquid-based) and possibly a second, deeper biopsy.
STEP 9 MONITORING UNTIL COMPLETE REGRESSION
• Digital follow-up: smartphone macro images uploaded to our secure AI-triage platform; automatic change-detection alerts.
• High-risk patient education: strict smoking cessation counselling; alcohol reduction; nutritional advice (Mediterranean diet).
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ADVANCED DIAGNOSTIC TOOLS PROPOSED
• MRI (3 T) tongue/floor coil → map tumour thickness, perineural spread, marrow infiltration.
• Cone-beam CT → dental hard-tissue status and bone infiltration.
• Narrow-band imaging (NBI) endoscopy → vascular pattern analysis.
• High-frequency intra-oral ultrasound (20 MHz) → real-time depth measurement.
• Salivary molecular panel (mRNA-seq, TP53, NOTCH1 mutations, methylation signatures) – available in study setting.
• AI-assisted cytology grading – in house (validated AIDOC model; accuracy 94 %).
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SHARED DECISION-MAKING SUMMARY FOR MR FREUD
1 We recommend an immediate incisional biopsy under local anaesthesia after informed consent.
2 Pre-biopsy imaging (MRI + ultrasound) is advisable the same day to avoid post-biopsy artefacts.
3 Smoking cessation support (nicotine replacement, varenicline) and alcohol reduction plan start today.
4 Depending on histology, we will either:
a) excise residual dysplasia with laser under local anaesthesia, or
b) convene the multidisciplinary Head & Neck Tumour Board for oncologic resection and neck staging.
5 Nutritional and psychological counselling (anxiety due to family cancer history) offered.
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PROVISIONAL ICD-10 codes (awaiting histology)
K13.79 Leukoplakia/erythroplakia, unspecified site
R22.0 Localized swelling/lump in head and neck
Z87.891 Personal history of nicotine dependence
Please feel reassured that every step strictly follows the current German S2k-guideline and is supported by state-of-the-art imaging and AI diagnostics available at our centre. We will keep you informed about the histology result (expected within 48 h). In the meantime, avoid further irritation of the lesion and return immediately if bleeding, increased pain, fever or trismus occur.
With kind regards
AIDOC, PhD
Medical University Vienna
(AI generated)
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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