A summary of: Peter Glen and Etienne Botha, BDJ Team 2022 Nov;233(9):726-730. doi: 10.1038/s41415-022-5198-2
Head and neck cancers refer to malignancies that arise in the oral and nasal cavity, paranasal sinuses, pharynx, larynx and salivary glands. Squamous cell carcinomas (SCC) form 90% of head and neck cancers, while basal cell carcinomas (BCC) are the most frequently occurring cancers, commonly found in the head and neck area. Dentists play a key role in detecting these cancers with screenings at routine check-ups, and as appropriate, followed by urgent 2-week referrals to facilitate early diagnosis. Oral cavity cancers at early-stage disease had a 30% higher three-year survival compared to late-stage disease.
Risk factors for head and neck cancers include tobacco, alcohol, Human Papilloma virus, UV radiation and immunosuppression. Approximately 85% of head and neck cancers are linked to tobacco, so smoking cessation advice is imperative to cancer prevention. Alcohol plays a synergistic role in malignancy risk when paired with tobacco. UV radiation through sunlight increases the risk of skin cancer, and especially of the lips, ears and scalp.
Precancerous lesions are those which are at risk of becoming malignant. Erythroplakias have a 14-50% risk of malignant transformation. Comparatively, leukoplakia has a 2-5% risk whilst oral lichen planus has a 1-2% risk for non-erosive and non-atrophic types.
NICE guidelines are commonly used as criteria for cancer referrals, and naturally coincide with characteristic features of cancer. Some criteria for head and neck cancer commonly used in hospital referral proformas are simplified below:
-Unexplained ulceration of oral cavity or other mass lasting for more than 3 weeks
-Unexplained red or white patches including lichen planus, especially if painful, bleeding or swollen
-Unexplained swelling of salivary or thyroid glands
-Unexplained persistent sore throat, problems swallowing, speech changes, change in sensation or ear pain
-Oral cavity/lip lesions or other persistent oral symptoms that haven’t been diagnosed for more than 6 weeks
-Non-healing extraction sockets (more than 4 weeks) or suspicious mobility of teeth when malignancy suspected (particularly with numbness of lip)
Cutaneous malignancies like squamous and basal cell carcinomas have clinical variation, however general characteristics and features of melanoma are summarised below:
Any lesions that raise suspicion of SCC should be referred via the two-week urgent referral. BCCs should only be referred urgently if there is a concern that delay will have a significant impact e.g. near the eye or rapidly infiltrative.
Referrals regarding malignant melanomas (form of skin cancer) are based on the criteria in the table below. If the patient scores 3 or more, an urgent referral should be made. Where in doubt regarding skin lesions, the patient can be directed towards their GP:
After an electronic referral via hospital proforma, a follow-up phone call should be made. A detailed history, summary of clinical findings and photos, where possible, should be included. Although the patient should not be overly anxious, it is important to tell them the reason for referral and your concerns to make them more likely to attend the appointments. The patient should be seen within 14 days and informed of test results by 28 days.
Research Summary Written by: Meera Dhokiya, BDS4 – University of Birmingham