Pathology · single question
A 4mm candidal lesion on the upper premolar gingival mucosa did not respond to nystatin. What is the MOST appropriate next step?
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Correct answer: C. Incisional biopsy
A persistent lesion that fails antifungal treatment requires tissue biopsy to rule out dysplasia or malignancy.
- A. Excisional biopsy removes the entire lesion and is appropriate for small benign-appearing lesions. For a diagnostic-uncertain persistent lesion, incisional biopsy allows histopathology while being more conservative.
- B. Systemic fluconazole might be a next antifungal step but does not provide a diagnosis. For a treatment-resistant lesion, biopsy is the priority to rule out malignancy.
- C. CORRECT. Incisional biopsy is indicated for any persistent mucosal lesion that fails to respond to treatment. It provides definitive histopathologic diagnosis to rule out dysplasia or carcinoma.
- D. Exfoliative cytology is a screening tool — it cannot replace biopsy for a persistent, treatment-resistant lesion.