Biopsy, Cysts, Lumps & Lesions

What are different types of oral conditions?
What are cysts and should I be concerned?
Raised lumps or masses
What are various types of oral lesions?
I have a white lesion in my mouth. What could it be?
I have a pigmented lesion in my mouth. What could it be?
I have an ulcer in my mouth. Should I be concerned?
How do I know if something is cancer?
What should I do if I have a lesion, lump, or other abnormalities?
What are different types of biopsies?
How long does it take to get results back?
Recovery

What are different types of oral conditions?
Pathological conditions that may occur in the mouth include: cysts (cavities in the jaw bone), masses (any lesion that is raised or like a lump), ulcerated lesions (painful areas where tissue has eroded), lesions (may be pigmented, white, red, or combination). Any abnormality must be evaluated and treated as soon as possible by an oral surgeon.

What are cysts and should I be concerned?
Cysts are cavities in the jaw bone with a thin lining and fluid inside. Cysts may occur in upper or lower jaws. The majority of cysts of benign and are associated with teeth. They are called odontogenic cysts. They are asymptomatic in most patients and are usually discovered during routine dental examinations. Pain and swelling may develop if cyst becomes infected. Although most are benign, cysts can grow and cause significant destruction of the jaw bone and surrounding teeth. Some cysts may transform into more serious and aggressive lesions.

Raised lumps or masses
Lumps can occur anywhere in the mouth: lips, gum tissue, cheeks, tongue, or palate. Such lumps (also known as a mass) may develop quickly or over months or even years. Some remain the same size and do not change their characteristics. Some change in size, color, and symptoms such as pain. Most are benign masses and are not serious. The most common benign mass is a fibroma, which forms in response to irritation or trauma. Raised lumps in the lower lip are often salivary-gland related (known as mucoceles). Other masses may be viral or bacterial related and therefore are inflammatory. Yet other masses maybe from other origins, such as nerve, muscle, or salivary tissues. A lump may also be an aggressive mass or cancer, especially when it grows rapidly, is painful, and has a broad attachment to the underlying tissues.

What are various types of oral lesions?
A lesion is a general term referring to an abnormality in the tissue. Lesions may be flat or raised, ulcerated, painful, acute or chronic, and have different causes. Whatever the cause or appearance, a lesion is not normal and must be evaluated and treated.

I have a white lesion in my mouth. What could it be?
White lesions are quite common and may be completely benign or precursor of cancer tissues. Majority of white lesions that are flat are related to irritation and are known as hyperparakeratosis. They may also be in response to fungal infections. More concerning is the white lesions that are precursors of neoplasm (tumor). Early neoplastic changes can appear white and may represent dysplasia (involving partial thickness of the mucosa) or carcinoma-in-situ (involving full thickness of mucosa). A biopsy must be done as soon as possible to establish diagnosis. If neoplastic changes are noted, further treatment may be recommended.

I have a pigmented lesion in my mouth. What could it be?
Pigmented lesions present as brown, red, purple, blue, or in combinations of. The most concerning pigmented lesion is melanoma, which is cancerous and can appear brownish. Red lesions may represent precursor to oral cancer, especially when they are mixed with white lesions. Red or purple lesions may represent a hematoma, which is a benign vascular lesion. Blue-purple lesions are mostly nevus (similar to a birth mark), which are also benign. A biopsy is recommended to establish diagnosis.

I have an ulcer in my mouth. Should I be concerned?
Ulcers are lesions that have lost their surface covering and are frequently painful. They may be due to irritation or trauma, bacterial / fungal, or oral cancer. Most ulcers that are reactive or due to irritation are benign and heal spontaneously. However, any ulcers that  do not heal after 10 to 14 days may be oral cancer and should be evaluated immediately. Such ulcers are of particular concern when they occur under or side of the tongue, floor of mouth, or in the back near the throat.

How do I know if something is cancer?
Cancerous lesions may have all or some of the following characteristics:  Painful, ulcerated, rapidly growing, broad-base and attached to the underlying tissue, numbness, irregular growth with rolling borders, and bleeding. Any lesions with such characteristics need immediate evaluation and biopsy.

What should I do if I have a lesion, lump, or other abnormalities?
If you have a new lesion see your dentist or oral surgeon for immediate evaluation. For some lesions, observation and re-evaluation in 10 to 14 days may be recommended. In others, immediate biopsy may be indicated to establish early diagnosis and treatment.

What are different types of biopsies?
Enucleation biopsy is performed for jaw cysts where the lining and content of the cyst are removed. It may be a partial enucleation in large cysts (to establish biopsy) or a complete enucleation in relatively smaller cysts.
Excisional biopsy is performed on any lesion, lump, ulcer, or other abnormalities. The lesion is completely removed, therefore providing biopsy and definitive treatment in one stage.
Incisional biopsy is performed when the lesion/mass is large and it is important to establish diagnosis before the definitive treatment. A section is removed as a sample and sent to the laboratory for histology reading.
Brush biopsy is performed by swapping a cotton over the mucosa surface and obtaining sample cells and sent to a lab for reading. Some dentists recommend it because it is non-invasive and easy but, it is not very reliable. it is associated wit many false negatives or positives and does not provide sufficient diagnosis.  If it is positive, then a regular biopsy is required.
Fine needle biopsy is performed by placing a fine needle into a mass to obtain sample tissue. Although not conclusive, it is a useful adjunctive tool in diagnosis. It may be beneficial for some cysts or masses in the jaw bone.

How long does it take to get results back?
We submit all biopsies to Johns Hopkins, department of dermatology and oral pathology for processing and diagnosis. Results are usually ready in 5-7 days.

Recovery
Most soft tissue biopsy procedures are relatively minor and minimally invasive. Biopsy of cysts or large masses are more invasive and require longer recovery

Pain: Level and duration of pain depends on the complexity of the surgery, technique, and patient’s tolerance. Most patients experience three to four days of elevated pain, commonly managed with pain medications such as Vicodin or Percocet. As pain gradually diminishes over the next two to three days, Ibuprofen (Advil) or Acetaminophen (Tylenol) can be used. After seven to ten days, most patients no longer have pain and may stop their medications.

Swelling: Any swelling related to surgery will maximize in 36 to 48 hours following procedure, and gradually taper over the next five to seven days. Ice helps to reduce swelling in the first 24 hours. With minor biopsy procedures there is typically no or very mild swelling.

Diet: Upon arrival home, patients may have water, juices, soups, shakes, puree, and very soft food. A soft diet is recommended up to five to seven days. No hard, crispy, or spicy should be eaten during this period. The general rule is if you have to chew, it’s probably too hard.  After seven days, patients may gradually return to normal food.

Activity: Get plenty of rest on day of surgery. Some patients may feel well enough the following day to walk and go out. That’s all right, but take it easy. Avoid strenuous activities for the first two to three days. Refrain from sports, lifting, or doing anything that requires exertion. After three days, if patients feel more comfortable, they can walk, go for a  gentle swim, or do very low-impact exercise., such as swimming or walking.  Mild activities may cause some pain but not enough to disturb the surgery site or open the sutures.

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