Wednesday, 30 January 2013

One step forward, one step back ....

OK, so I have not received an email or letter in response to my query regarding the change in measurements of Feckit and Fuss, but I have been sent an appointment at the Oncology/Radiology Clinic for 21 February. I kind of get the feeling that I have offended someone by asking .... but I will have my questions answered in person at least!

Another development in this ongoing health saga is that when I saw the dentist for my six-monthly check at the beginning of the month she was concerned to find a small dark red area high on my gum above my front teeth. The area is completely painless and I was not aware of its existence as it is so high up. Anyway I was referred to the oral surgeon for his opinion and saw him last Monday following a short wait of 3 weeks.

The oral surgeon (OS) was concerned to find that the discoloured area has now turned black although it is painless unless probed or forcibly pushed on. After taking a full medical and dental history he went on to explain several possible conditions which can cause pigmentation in the mouth and identified the most likely which might be implicated in my case.


"The oral cavity is a common site of various brown or black pigmented lesions, e.g., amalgam tattoo, pigmented nevi, Addison’s disease, Peutz-Jeghers syndrome, racial pigmentation, melanotic macules associated HIV infection, smoker melanosis, drug-induced pigmentation and melanoma."


"The amalgam tattoo is a frequent finding in persons who have had amalgam restorations (ie, fillings). When the amalgam is removed with a high-speed dental handpiece, amalgam particles can be embedded or traumatically implanted in the oral mucosa. Silver from the amalgam leeches out of the embedded particles and stains (ie, tattoos) selected components of the fibrous connective tissue (eg, elastic, reticulin, oxytalan fibers) and highlights the blood vessels. The pigment is often solitary, macular, gray-black, and found near where amalgams were placed and subsequently removed."

Because this lesion has appeared where a "post" from a capped tooth was removed in 2009, just prior to commencement of my radiology treatment, OS feels that it is possible that this might well be the cause. 

INFECTION:

The OS felt that infection, although a possible cause, was less likely as there are no visible signs such as swelling, exudate or pain.


This he felt to be another possibility resulting from the "post" removal followed shortly after by radiation therapy, which may have compromised the blood supply to the bone.

MELANOMA:


Oral melanomas arise silently, with few symptoms until progression has occurred.
Most people do not inspect their oral cavity closely, and melanomas are allowed to progress until significant swelling, tooth mobility, or bleeding causes them to seek care.
Pigmented lesions 1.0 mm to 1.0 cm or larger are found.
Reports of previously existing pigmented lesions are common. These lesions may represent unrecognized melanomas in the radial growth phase.
Amelanotic melanoma accounts for 5-35% of oral melanomas. This melanoma appears in the oral cavity as a white, mucosa-colored, or red mass. The lack of pigmentation contributes to clinical and histologic misdiagnosis.

"The prognosis of Primary Oral Melanoma (POM) is much worse, with 5-year survival rates generally ranging from 10% to 25%, or according to some authors 15%-38%, partly because of diļ¬ƒculties to detect pigmented lesions and poor resectability due to the anatomy of the region, major extension in depth versus cutaneous melanoma, and early metastasis.

The median survival for all POMs is slightly over 2 years (18-46 months) from the time of diagnosis, depending on lymph node involvement, increased tumor thickness, and level and vertical growth phase of the tumor at the diagnosis. POM is an uncommon malignant tumor that originates from melanocyte proliferation.

BETWEEN A ROCK AND A HARD PLACE!  .......... That is how my OS described the position with regard to any treatment! 

If he excises the area and finds bone destruction (osteonecrosis) the healing time may be very long because of the prior radiotherapy.

But because there is a small chance that it may be a melanoma then the area must be excised and sent for histology as soon as possible in order to get a definite diagnosis. 

I understood only too well what he was saying and felt that a definite diagnosis was essential for both of us in order to plan how to proceed. So I am booked for an excision under local anaesthetic on 11 February.

I am hopeful that this little black area on my upper gum is merely an amalgam tattoo from all the previous dental work that this tooth received.


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