Abstract
This report presents an unusual neck lesion, initially seen by a dental surgeon. The lesion had been present for more than 4 weeks, was asymptomatic, slowly increasing in size and proved to be diagnostically challenging from a clinical, radiological and histopathology perspective. Following excision and full histopathological analysis, a definitive diagnosis remains elusive.
This demonstrates the importance of the dental surgeon as the first point of patient-contact and the patient’s relationship with numerous multidisciplinary teams. Promotion of healthy living, screening for abnormal lesions and early referrals by dental surgeons improves prognosis and patients’ quality of life. All clinicians need to be vigilant.
1
Introduction
50 % of the population will have cancer at some stage of their life. Deprivation increases this likelihood. Known risk factors include genetics and behaviour. Screening can lead to early detection and treatment.
One of the most common UK cancers is breast, with 56,822 new cases a year, which is 15 % of all cancer cases in both females and males from 2017 to 2019 [ ]. Breast cancer metastasis may be the first presentation of the disease [ , ]. This is commonly found in decreasing prevalence in lung, bone, liver, adrenal, brain, skin and kidney [ , ]. The most likely location for skin-involvement is the chest-wall, whereas it is less common to find secondary involvement of the skin in the neck [ ]. Presentation includes nodules (46.8 %), to occult metastasis (0.3 %) [ ].
This report presents a diagnostically challenging neck-skin lesion identified on a routine dental examination, involving tertiary care multidisciplinary teams.
2
Case report
A 66-year-old female attended for yearly dental review. A skin change on the right-side of the neck had been present for 4–6 months, gradually increasing in size.
Medically, Amlodipine (dihydropyridine calcium-channel blocker) and Atorvastatin were taken, and untreated generalised mild eczema was reported.
A family history of cancer included: sister died of lung cancer aged 50, father died of rectal cancer aged 80, and mother had breast cancer aged 80.
Social history; lifetime non-smoker, alcohol consumption of 4 units per week and non-sun seeker.
A superficial lesion located on the right-side of the neck, level 5, behind sternocleidomastoid muscle was raised ( Fig. 1 ), approximately 30 mm × 20 mm, mild-pink with overlying dilated blood vessels (Telangiectasia), firm, rubbery and mobile, without tenderness, suppuration, bleeding or trauma history. Intra- and extra-oral assessment was otherwise normal.
Differential diagnoses included:
- •
infective
- •
inflammatory
- •
trauma
- •
scar-tissue keloid
- •
neoplastic
- •
benign or malignant
- •
primary or secondary
- •
- •
idiopathic.
Referral to an Oral and Maxillofacial Consultant resulted in an 8 mm punch biopsy being sent as ‘urgent’ to histology, leading to differential diagnoses of:
- •
neoplasia
- •
reactive lesion
- •
reorganising lesion.
Healing was uneventful.
Immediate referral was made to the Breast Team, who subsequently referred to the Skin Team.
A malignant epithelial neoplasm was suggested, which, following investigation of molecular markers, was compatible with breast carcinoma ( Fig. 2 , Table 1 ). Primary cutaneous adnexal tumour was also considered, whilst histology suggested a primary skin tumour – however, features favoured a breast primary, which had to be excluded.
Stay updated, free dental videos. Join our Telegram channel
VIDEdental - Online dental courses
