Leukoplakia Biopsy Indication — ORE Part 1 MCQ

Correct answer: A — Refer through the urgent suspected cancer pathway

The lesion is a persistent, unexplained white patch. SDCEP advises referral through the local Urgent Suspicion of Cancer pathway when a red, white, or mixed red-and-white oral patch has persisted for 3 weeks or more, to investigate dysplasia or malignancy. At 6 weeks, this threshold has clearly been exceeded. Referral is the appropriate primary-care action; specialist assessment will establish the diagnosis and determine whether and where biopsy is required. A further 6-month review would inappropriately delay investigation. Antifungal therapy is unsuitable because candidal plaques are typically removable and there is no clinical basis for presumed candidosis. Topical corticosteroids should not be used empirically for an unexplained persistent plaque, as this can delay diagnosis. Reassurance and routine recall are unsafe because oral epithelial dysplasia cannot be excluded clinically.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Management of Acute Dental Problems: “Intra-oral swellings and abnormal appearance”, current online guidance. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/less-common-oral-conditions/intra-oral-swellings-and-abnormal-appearance/