I have been exchanging Christmas wishes with a few patients and survivors this morning, unfortunately I know a large number of this group who will be spending this day alone. It’s not widely discussed, but our cancer has one of the highest suicide rates. The holiday season for those without a family/friends support system around them are highly vulnerable to depression. It’s also the season with the most incoming contacts from newly diagnosed patients to OCF. But last nights and this mornings conversations reminded me of how many people, women particularly, have their cancers first discovered on the ventral side of the tongue, with no risk factors in their life style, a a small white lesion. It’s a large number.

People assume that as you said in your first post, that they bit or burned it and the white tissue is a result. The tissues of the mouth heal very rapidly, faster than almost any other in our body. Mother Nature designed things this way since they suffer a huge amount of insults, and they need to be replaced quickly and frequently through apoptosis. Things that stay around for protracted periods are always suspect. I failed to ask you about any risk factors like tobacco use your husband might engage in. And that is an important question. It’s almost impossible to bite the underside of your tongue even if you try. The borders of the tongue yes, not the underside. Burning it on hot pizza cheese (the most common culprit) is possible but not the first area that would get burned. Smokers leukoplakia is very common, and path result are often, if done early, atypical, or the pathology will clearly say leukoplakia. So does he have any risk factors such as tobacco or alcohol use? You can still get these lesions if not, but they arise from a different issue. And I didn’t ask how big it was or if during the time that he has been aware of it it has changed size. I also did not ask how the biopsy was performed. As you can see these conversations today have me second guessing how well I replied to you.

There are some biopsy techniques like brush cytology, that are far less accurate at obtaining a good sample to be evaluated than an incisional or punch biopsy. In the later, all the layers of cells, their architecture from surface to deep are all in place, there’s a lot more information available. A brush collection system harvests a sampling of loose cells, more like scrambled eggs. A person examining them has little idea where in the hierarchy of things any atypical cell came from. It’s a less than ideal technique, and it’s generally used as a preliminary screening, that if positive or atypical finding, MUST be followed by a conversational incisional biopsy. General dentists use it a lot, they loathe to pick up a scalpel or deal in things that involve any blood.

Bottom line, there’s some “we don’t knows” here. If the area is removed by laser, everything may be fine and it will be gone. But there is no remaining tissue removed to send for pathology again. Which should be done to a different pathology lab than the first, to confirm margins and confirm the original finding. This is most likely over thinking all this. It’s probably some simple pre cancerous change that will be 100% eliminated by the laser. But if I have given you incomplete advice and it returns, you are back at square one with something that needed a deeper removal, and I have helped you less than you think. You can discuss all this with the oral surgeon who is ultimately the person you need to have confidence in and has actually seen the lesion. I’m a stranger on the Internet that has not examined him, nor seen the pathology. We all want to get this right.