Hello,

Thankful that the biopsy of my tongue leukoplakia lesion came back non-cancerous.

Pathology report:

"MODERATE EPITHELIAL DYSPLASIA, EXTENDING TO THE TISSUE EDGES [K13.21]
PARAKERATOSIS AND CHRONIC INFLAMMATION


"The tongue mucosa is covered by a thin to moderate layer of parakeratin. The spinous layer exhibits moderate epithelial dysplasia characterized by dyskeratosis and focal dyscohesion and cells with increased nuclear: cytoplasmic ratio, involving up to two thirds of the thickness of the epithelium. Many apoptotic cells are noted and there is focal spongiosis and leukocyte exocytosis. Rete ridges are slightly bulbous and there is thickening of the basement membrane zone. A moderate lymphocytic infiltrate is present at the interface."

So my understanding is that dysplasia is a possibly pre-cancerous condition of cellular disorganization and intracellular changes, and that moderate oral epithelial dysplasia is currently understood to develop into cancer roughly 10% of the time, the tongue being a location where it is more apt to.

A couple questions come to mind that I wondered what various folks might advise.

The oral surgeon wants me to go back in 6 months to see what the biopsy region looks like and to decide to do another biopsy or whatever then. (Once I've tossed a few ideas around here and have thought about this more I'll follow up with my doctor via email, but wanted to kind of develop my thoughts to ask better questions kind of thing...). The Oral Surgeon did answer my question if anything changes at the biopsy site to contact his office to be seen sooner. He was surprised with the pathology report as he did not expect dysplasia at all for the small 4 mm round ulcer.

1.) So one issue is that the biopsied tissue has dysplasia extending all the way to the margins. Obviously if this was cancer they'd want to go back in right away and do something to address that. Seems to me that the ideal case would be to eradicate the dysplastic cells, so that there would no longer be dysplastic cell lines to develop. Wouldn't that be the ideal case, to remove all dysplastic cells? I've read some posts where after a small biopsy of a larger region of leukoplakia folks opt to have the larger visible leukoplakia region removed. But in my case the visible lesion was excised, but microscopically apparent dysplastic cells remained at the margin.

2.) I've observed other tiny dimples in the area around the ulcer, (pre and post biopsy) that are unique to that area, and white lines extending from the ulcer. The lines went away. The dimples remain. The texture of the tongue tissue in that general area seems different. The doctor did not use the Toluidine blue or any kind of other light device to examine my tongue/mouth and the physical exam was quite brief. No palpation of the tongue or base of mouth, but he did check neck lymph nodes. I mean he grabbed my tongue to yank it out to see the ulcer, but didn't really feel it. Part of me wonders if their is tissue outside of the visibly obvious portion he excised that may harbor worse dysplasia, either deeper in the tongue or around the perimeter of the excision. I've taken many pictures of it with iPhone--getting the phone to capture what the human eye can see close up is not easy. I was going to show the Dr. pictures of it and ask him on my iPad but kind of chickened out--not wanting to appear a total kook. They aren't as noticeable as the ulcer he cut out, but it is apparent to me there is more going on in that area.

3.) I did mention to the oral surgeon I was experiencing difficulty swallowing, had taken a few pills and one got stuck in the back of my throat (never happens to me, usually can swallow horse pills A-ok) and I kind of choked on it for a good 30 seconds (able to breath, but it was lodged in back of throat triggering gag reflex etc...). I kind of discounted it and suggested maybe it was just due to general throat inflammation, that I had tonsil stones on the right side of throat (same side as this tongue lesion, and same side of a lower right molar that had to be re-root canalled due to infection, several years later). He didn't ask any follow up questions on that. Since then the swallowing has not been a problem.

4.) Ongoing "dry throat" feeling. Way back in throat, almost like it feels like if you have a stuffy nose and breath through your mouth all night and the back of your mouth/throat is dried out from mouth-breathing dry winter air all night. It isn't painful, but feels kind of "scratchy". Swallowing in general feels like something is swollen still (could just be post-nasal drip/sinus/throat inflammation--but new normal for me now for some reason).


I am not keen on the idea of having a repeat tongue biopsy. Two weeks since my tongue is totally recovered pain wise, first 5 days were pretty rough. Unlike my dentist he did not use any topical anesthetic before putting the Novocain needle in...that really made me ready to confess state secrets...only a few seconds but boy did my eyes water. The squeezing of the tongue and yanking it hard out of my mouth to access the ulcer kind of distracted me enough from the sharp needle pain that I made it through. I think I'll ask about topical numbing before the needle next time. Maybe on the tongue the topical stuff doesn't do much. Works great on my gums when the dentist puts it on there before needling. Was a big old purple contusion at the injection site that lasted a good 5 days and was about as bad as the incision site.

I'll be keeping a close eye on the area, and will perhaps email the Dr. back with the pictures and ask him about the other area.

If he is going to re-biopsy the same location 6 months from now I'd almost rather he take a larger part of the tongue and get it over with, get rid of the dysplasia altogether (I gather from others' posts that even if biopsy says it's all removed it is apt to recur), but how do you ask the expert to consider using some kind of adjunct (Toluidine blue or whatever) to visualize less obvious parts of the tongue that appear altered to the laymen's eye?

10% is a small risk, but still I'd much rather them take a quarter sized chunk of out my tongue now than to deal with something like a partial glossectomy or worse down the road.

I am not really worried or bothered about it all, just trying to do what seems prudent and reduce risk as much as possible (having read what many others on this forum with actual cancer have had to endure--something to avoid if at all possible).

Sorry for the war and peace novel, but that is kind of what is rumbling through my mind.

Thankful to have a working tongue this Thanksgiving, and my wishes and prayers for all those unable to enjoy the normal use of their tongues due to surgery/radiation/chemo and not able to use their tongue to swallow normally.

I've come to really appreciate my tongue!

A penny for anyone's thoughts...thank you in advance.