CDA Essentials 2018 • Volume 5 • Issue 7

34 | 2018 | Issue 7 S upporting Y our P ractice Case presentation: A soft tissue lesion that kept coming back Theviewsexpressedarethoseoftheauthor anddonotnecessarilyreflecttheopinions orofficialpoliciesoftheCanadianDental Association. Erin.Watson@ uhn.ca Dr. Watson is a general dentist at the Princess Margaret Cancer Centre in Toronto who treats oncology patients. This case presentation is about a male patient who presented to Dr. Watson with an abnormal lesion in his mouth. Her key message: “It is always the best course of action if you have a patient with a soft tissue lesion and radiographic changes to assume that this is a malignancy until proven otherwise, and to take an incisional biopsy for histopathological confirmation.” A 57-year-old man presented to the dental oncology clinic at the Princess Margaret Cancer Centre (PM) with a concern about ongoing swelling in his gums. This patient was known to the dental clinic and had historically been followed by his usual health care providers—an otolaryngologist, medical oncologist/hematologist and an oral pathol­ ogist. As this was an unscheduled visit, he was referred to the next available dentist, Dr. Watson. Patientmedical history A comprehensive medical history was taken. The patient had been diagnosed with aplastic anemia in 1999 and is one of PM’s longest aplastic anemia/allogenic transplant survivors. He had suffered from chronic oral and systemic graft versus host disease (GvHD) since having his transplant. In 2016, he developed oral cancer on the left side of his tongue, a condition that is more common in patients who have GvHD than in the general population. 1,2 His tongue cancer was treated by surgical resection alone, as he was deemed to be an unsuitable candidate for post-operative radiation due to his history of chronic oral GvHD. In 2017, he had loco-regional recurrence in his left neck, which again, was treated surgically by neck dissection. History of the present illness The patient described a large mass on his gums, causing pain when eating and brushing his teeth. He estimated that the swelling had been present for about four Dr. ErinWatson Figures 1a) and 1b) : A large exophytic mass between teeth 35 and 36, with clear regions of leukoplakia and erythema. Figure 2: Radiograph showing abnormal appearance of alveolus between teeth 35 and 36. a b