Oral Melanoma — ORE Part 1 MCQ

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HardOral MedicineOral MelanomaORE Part 1

During a routine examination, a dentist identifies an 8 mm pigmented patch on the lower labial mucosa. It is asymmetric, has an irregular outline and contains several shades of brown and black. The patient is unsure how long it has been present. What is the most appropriate next step?

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Correct answer: B — Refer urgently through the suspected-cancer pathway

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

A is correct. Asymmetry, an irregular border and colour variegation make this an oral pigmented lesion suspicious for malignancy, so it requires urgent specialist assessment through the local urgent suspected-cancer pathway. SDCEP specifically advises referral of persistent pigmented oral areas via this pathway to investigate dysplasia or malignancy, and NHS England categorises suspected cancer as a 2-week-pathway priority. Photography may assist documentation, but it must not substitute for urgent referral in this high-risk presentation. Reassurance based on rarity risks diagnostic delay. Primary-care excision is inappropriate because specialist assessment and biopsy planning are required. Antifungal treatment has no indication for an asymmetrical, irregular, variegated pigmented patch.

Reference: Scottish Dental Clinical Effectiveness Programme. Intra-oral swellings and abnormal appearance: Management of acute dental problems. Current online guidance. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/less-common-oral-conditions/intra-oral-swellings-and-abnormal-appearance/