Oral Cancer - Referral of Patients with Suspicious Lesions
The Pathway of Care shows how a patient with a (District General Hospital) and seen within 2 weeks (in the UK).

If the lesion is thought to be suspicious, then investigations, imaging ± biopsy are carried out.

The biopsy results are 'fast-tracked' and the patient would be seen with the histological results of the biopsy,
investigations & imaging results at the
MDT (Multi-Disciplinary Team) meeting (held in my area, down at Maidstone
Hospital, Kent).
The suspicious features that the GDP should be aware of are listed here (high-lighted in yellow); these are in a box
on the
Rapid Referral Form.
Last Updated 1st January 2020
Useful Websites:

Cancer Research UK

Oral Cancer LDV

Clinical Knowledge Summaries

British Dental Association / Cancer Research UK, National Oral Cancer Toolkit

National Institute of Clinical Excellence

MacMillan Cancer Support

Useful Articles:

NICE Guidelines 2004.  Healthcare Services for Head & Neck Cancers.  Understanding NICE Guidance –
Information for the Public

J Can Dent Assoc 2008.  Biopsy & Histopathologic Diagnosis of Oral Premalignant & Malignant Lesions

BDJ 2010.  Study of the Experience of Primary Care GDP's in the detection & Management of Potentially Malignant
Lesion. 1. Factors influencing detetction & the Decision to Refer

BDJ 2010.  Study of the Experience of Primary Care GDP's in the detection & Management of Potentially Malignant
Lesion. 2. Mechanics of the Referral & Patient Communication

Dental Update 2011.  Importance of Quality in Referral Letters Sent for Potentially Malignant Oral, Head & Neck

Head & Neck Cancer Guidelines 2011

BDJ 2015.  Why Don’t Dentists Talk To Patients About Oral Cancer?

Dent Update 2016.  Mouth Cancer for Clinicians Part 8. Referral

NICE Guidelines 2017.  Head & Neck Cancer

BDJ 2018.  Mouth Cancer - Presentation, Detection & Referral in Primary Dental Care

Dental Update 2020.  Mouth Cancer - the Maxillofacial Surgeon’s perspective

Dental Update 2020.  Mouth Cancer – What is it to Me & You
These are the referral forms for suspected neoplastic / mitotic lesions - these are filled out & sent electronically
When consulting with your patient it is important that you record clinical status, signs, symptoms, referral process &
what information & advice you gave the patient both verbally & in writing.

Records should be kept In-line with authoritative and professional guidance.
A “best practice” Head & Neck referral (below)
Information given to a patient should cover:

  • What an urgentTwo Week’ referral is
  • Why the patient is being referred to a 2nd care cancer service
  • The percentage of urgent ‘Two Week’ referrals that are cancerous
  • Which 2nd care cancer service the patient is being referred to
  • How they will receive their appointment
  • The importance of attendance
  • Whether the patient can take someone with them
  • What type of tests / investigations that might be carried out & how long it will take to get results & a diagnosis
  • How to obtain further help & information about the type of oral cancer suspected

take home.