Ethics & Law · patient case question
To which two specialists is referral most appropriate?
Patient case: Multiple jaw radiolucencies in a patient with recurrent skin cancers
Patient: Female, 26 years old
Chief Complaint: “My dentist saw some dark areas on my x-ray.”
Background: Chart records excision of FOUR basal cell carcinomas from the face and trunk since age 19. Chest imaging previously reported a BIFID RIB. Frontal bossing and hypertelorism noted. Mother had similar skin lesions.
Vital Signs: BP 116/70 mmHg · HR 74 bpm
Findings: Panoramic radiograph shows MULTIPLE well-defined, corticated MULTILOCULAR radiolucencies in the posterior body and ramus of the mandible bilaterally, and one in the maxilla. Minimal buccolingual expansion for the size of the lesions. Palmar pitting is present.
Show answer and explanation
Correct answer: D. Oral and maxillofacial surgery, and dermatology
- A. Periodontics and endodontics treat conditions this patient does not have. The lesions are developmental odontogenic cysts, not inflammatory lesions of pulpal or periodontal origin.
- B. Prosthodontic and orthodontic input may eventually be needed if teeth are lost with the cysts, but neither addresses either active disease.
- C. Paediatric dentistry is not applicable at 26, and while oral medicine may co-manage, it does not replace surgical enucleation or dermatologic oncology care.
- D. CORRECT. The two active disease processes are the JAW CYSTS and the SKIN CANCERS. ORAL AND MAXILLOFACIAL SURGERY manages enucleation of the keratocysts and the long-term surveillance they require, and DERMATOLOGY manages the basal cell carcinomas and screens for new ones — lifelong, since these patients develop them continuously and must avoid sun and, critically, IONISING RADIATION, which accelerates BCC formation. Genetic counselling for an autosomal dominant condition is the third strand.
Note: The radiation caution is the practically important point for a dentist: minimise radiographic exposure in these patients, use the fastest receptors and rectangular collimation, and avoid CT where an alternative exists — but do not abandon the surveillance imaging the keratocysts genuinely need. It is a balance, not a prohibition.