A patient has a family history of basal cell nevus (Gorlin-Goltz) syndrome. What imaging should you obtain?

Correct answer: B. A panoramic radiograph to screen for odontogenic keratocysts

• A. A periapical series is more time-consuming, delivers more total exposure, and can still miss lesions in the ramus and posterior body.
• B. CORRECT. Multiple ODONTOGENIC KERATOCYSTS are one of the major diagnostic criteria of basal cell nevus syndrome, and they are frequently the FIRST manifestation — often appearing in the first or second decade, before the basal cell carcinomas. A PANORAMIC radiograph screens both jaws in one image. Other features: multiple basal cell carcinomas, palmar and plantar pits, calcified falx cerebri, bifid ribs, frontal bossing, and hypertelorism.
• C. Bitewings image only the crowns and crestal bone — they cannot screen for cysts.
• D. Waiting for symptoms is inappropriate: keratocysts are typically ASYMPTOMATIC until they are large, and they have a high recurrence rate and aggressive growth pattern.

Note: The dentist is often the first clinician to identify basal cell nevus syndrome, precisely because the jaw cysts precede the skin cancers.