New and Established Patient Evaluation
- Acquisition of Medical and Dental Records: Key records to
obtain are clinical photographs (ideally from referring provider)
and/or photographs provided by the patient (Figure 3) of the lesion(s)
of interest; copy of biopsy report(s).
- Telehealth Consultation: This ideally should be video based,
and at our institution we are currently utilizing BlueJeans (Mountain
View, CA, USA) and Doximity (San Francisco, CA, USA) as video
conferencing platforms. A greater amount of details is obtained in
assessing a lesion via a photograph(s) than through video
conferencing; however, through video a greater spatial appreciation of
a lesion is achieved and better assessment for cervical
lymphadenopathy through video, which adds a greater degree of human
touch to the visit.
- Determine Urgency/Timing of In-Person Visit: This decision is
the most critical decision as one must balance social mitigation
efforts, reducing exposure risks to patients especially those deemed
as high-risk per CDC, and also providing medically appropriate care.
The timing of an in-person visit is largely predicated on the
likelihood of lesion being cancer (Figure 2A and 2B) and ongoing
mitigation efforts and surge capacity. One of the most critical
consideration from a clinical perspective is theprogression (development of symptoms and/or taking on
high-risk clinical features – Figure 4) of the lesion of interest.
Any clinical indications for progression must escalate
care and proceed with in-person evaluation. Should an institution
lacks the resources or capacity for care of the patient, then
collaboration with colleagues with familiarity and resources to care
for a patient with a OPMD will become necessary. We cannot
overemphasize the importance of absence or presence ofprogression of a lesion in part of this algorithm.
Of note, our rational for the use of the 3 month time point in low-risk
lesions is based on literature that indicates 0.7% of patients with
oral leukoplakia who go on to develop oral squamous cell carcinoma do so
within 3 months of diagnosis.5