My husband's dentist discovered a small leukoplakia and sent him to an oral surgeon for a biopsy; the results showed moderate dysplasia. He was referred to an ENT and saw the doctor the day after the biopsy results were returned.

According to my husband, the ENT appeared less concerned about it than the oral surgeon was. The ENT is scheduling surgery to remove it four to six weeks from now.

The ENT also said something along the lines of: "I'm not familiar with the lab that did the pathology results and can't really say how serious it might be until I remove it and send it to the lab we usually work with." (That's a paraphrase, not his exact language.) Do pathology reports really vary that much? Should my husband be pushing for surgery sooner?

The oral surgeon's office has been using that particular lab for less than a year, if that makes any difference. I do not know how many patients the oral surgeon refers to the ENT's office.

I guess my real question is: Should he seek another opinion? My gut says yes, but I tend toward over-concern.

If so, do any of you all have any recommendations in the Washington/Baltimore area? We are in northern Virginia; DC is fine, and Baltimore is an easy drive (my husband works up in that direction).

Thanks for your help and advice. I am grateful to know you all are here.

Lesley,

My ENT had the pathologist at KU Med go over the slides from my second biopsy. My dentist and primary care doc did not even get a report from the first one, and when I received it a year later they had had 3 doctors look at the slides before they signed it as clear. But the report itself mentioned possible SCC, dysplasia, etc. This was from a lab my dentist and second oral surgeon had never heard of.

Lots of labs have so many specimens go through and are paid by the number of slides read, and mistakes are made. I wanted to get the original slides read by someone else and people were encouraging me to sue the original oral surgeon. I asked my dentist if I were his wife, would he pursue this? He said he would concentrate on getting well. I still wonder what a second (actually fourth) opinion on the slides would find.

Maybe your ENT could have the pathologist he trusts read the slides from your biopsy? My doctor required they be sent to him before he saw me.

Sincerely,
Lisa

PS.. Original oral surgeon was the one on my insurance, not the one recommended by my dentist. That was a poor choice on my part to save money.

Lisa, thanks. I trust the oral surgeon -- my husband and I see different regular dentists, and this oral surgeon's office is where both dentists refer patients. The office is also highly regarded for its concern with oral pathology -- as opposed to just pulling wisdom teeth, for instance. (And it's not part of our insurance plan.)

That's a good idea about getting the slides read by the lab the ENT knows; I'll ask my husband if he can look into that. I am seeing my regular dentist tomorrow and will ask her what she knows about the lab (the oral surgeon's office gave me the name).

I think what bothers me more is the emphasis that the oral surgeon put on having this taken care of versus the ENT's "I'll take it out in a month or so." Or is that sort of delay common? If it were me, I'd want that sucker out of there yesterday.

Lesley,
I think it is pretty much the norm that a newly involved doctor wants to use his own lab to verify pathology. We ended up going for a second opinion from a different ENT and he insisted on having the original slides to send to his lab. And this new lab found something the prior lab had missed (extracapsular spread) which totally changed the treatment plan.

I'm a big believer in "gut feelings". If only for your own peace of mind, maybe you ought to look into that second opinion.

Best,
Anita

Lesley,

My experience has been (and this is only my own personal experience) that some ENTs are very casual about precancers and early cancer because compared to all of the late stage cases they see, this stuff is no big deal. One thing you may want to do is have an oral pathologist read your husband's slides. An oral pathologist is a pathologist that specializes in just oral pathology and they are the real experts at reading the slides of oral biopsies. Most dental schools, like the University of Maryland, have Departments of Oral Pathology.

By the way, my surgery was not done until seven weeks after my intial biopsy for several reasons, one of them because I saw four head and neck surgeons and had I a difficult time deciding where to have treatment. It did not make any difference in the outcome of my treatment.

I'm glad your dentist saw the leukoplakia and that your husband had it biopsied and that it was precancerous. It needs to work that way more often.

Barb

Barb, thanks from a former Philadelphian. The slides were indeed read by a lab that does only oral pathology, so I am comfortable with its conclusion. I expect the ENT's attitude may well be along the lines you suggest.

Largely for my peace of mind, muy husband is investigating seeing an ENT or oral surgeon at Hopkins. In the meantime, the surgery has been scheduled for the end of this month.

Lesley,
My experience when getting a second opinion was that the doctor providing the second opinion wanted his hospital's pathology lab to review the original slides. In my case, the second opinion was that my margins were not clean and thus needed additional treatment (radiation).

I've heard a number of stories from all sorts of cancer patients who say that the second opinion wsas different from the first, sometimes better, sometimes worse. My conclusion is that this type of pathological assessment is not a black and white decision, but rather requires a lot of experience, interpretation and possibly, intuition.

I think it will be helpful to have your ENT sent the slides to another lab for second reading. - Sheldon

Sheldon, thanks. As far as I know, the ENT to whom he was referred by the oral surgeon has not asked for the original slides. Should my husband be calling to see if he wants them read by the lab be usually uses?

As for the surgeon's apparent casualness -- as it happens, before she went to dental school my dentist was a surgical nurse at the same medical center where this ENT was once chief resident. This center sees the very worst cases out there, she said, and she -- like Barb -- attributed his attitude to that.

I've learned a little more about what is going on. The ENT is doing an excisional biopsy, according to the papers we received from the surgery center.

And a week before his scheduled surgery, my husband's also seeing an ENT at Hopkins for a second opinion, so the slides from the first biopsy will indeed be read by a second lab.