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Biopsy Flow Chart

Biopsy Flow Chart

Prepared by Andrea Nelson

As partial requirements for Dental Diseases 1 – DHYG 280

Date Submitted: February 12, 2024


Biopsy Flow Chart
Found a Lesion Step 1: Document
- Consider variations of normal! - ABCDE+L/MCATSS
- Photograph
- Symptoms?
2
Step 2: Review HH Step 3: Demo OSE Step 4: Create a Differential Dx list.
- Pt Risk factors? - Discuss importance of - Consider possible etiology
- Lesion timeline/history OSE 1x/month - Consider pt risk factors/lifestyle

Step 5: Determine level of suspicion

Etiology/Pathology Discovered? - Use adjunctive tools (Velscope/Toluidine
blue)
Biopsy - Refer to DDS or Oral surgeon for
confirmation/opinion

No Dysplasia/ Dysplasia/
Benign1 Malignant1
High Lvl Suspicion3
- Erythroplakia/SCC1 Low Lvl Suspicion3:
2-3 wk. Patient Consent - Positive Velscope results
Follow-up Refer to Oral Surgeon - Pros/Cons - High risk location
or Cancer Clinic3 - Benefit/Risk - Active bleeding w/out
Or: - May req. physical documentation hemostasis
- Avoid triggering vocabulary
Not healed: Lesion Healed
Attempt Therapeutic Dx
- Document progression/
regression (if any) - Remove possible irritants
- Provide tools/topicals PRN

2-3 wk.
- 3-6 mo. Follow up Follow-up
Refer to Oral Surgeon
or Cancer Clinic
- Reinforce OSE
- Continue to
STOP Patient refusal2: STOP Or:
Or: document PRN
- Explain the importance of biopsy and/or following up
- Can’t rule out cancer as a possibility without confirming Not healed: Lesion Healed
- Document progression/
via biopsy regression (if any)
2nd - Offer alternate biopsy/treatment options where applicable
- Documentation of refusal (refusal form)
Biopsy
- Remember: pt has 100% right to refuse treatment/biopsy2 - 3-6 mo. Follow up
or opt to discontinue treatment at any time. - Reinforce OSE
- Continue to
document PRN
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Biopsy Flow Chart
DHYG 280 Dental Diseases 1
Assign #1 - Lesion Flow Chart Rubric (15%)

Name: Total Points: /45

Component Rating Scale (circle)

Lesion identification 0 = failed to meet
Begins flow chart with lesion identification 1 = met
Lesion documentation 0 = failed to meet
Documents lesion at appropriate point using ABCDE’s or MCATSS, takes a photo 1 = partially met
2 = met
Patient Questions 0 = failed to meet
Asks patient appropriate questions - is patient aware, how long has it been there, any 1 = partially met
pain, what makes it better/worse, can it be wiped off, any trauma to the area, use of 2 = met
drugs/alcohol, any allergies, etc.
Historical information 0 = failed to meet
Checks patient chart for history of lesion (info can come from HH, CPN or any place in 1 = partially met
the chart). Includes pathways for lesion changes or no changes if there is historical info 2 = met
in chart. Formulate list of DD.
Intro/Review OSE 0 = failed to meet
Includes patient education & demonstration of an oral self-exam at an appropriate 1 = partially met
point 2 = met
Apply Therapy 0 = failed to meet
Includes pathways that consider removing irritant or applying therapy prior to re- 2.5 = partially met
evaluation at an appropriate point 5 = met
Initial Re-evaluation 0 = failed to meet
Includes first timeframe for lesion follow-up at appropriate point 2.5 = partially met
5 = met
Adjunctive Screening Tools 0 = failed to meet
Incorporates at appropriate point 1 = met
Level of Suspicion 0 = failed to meet
Includes pathways for high or low level of lesion suspicion at appropriate point 2.5 = partially met
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Biopsy Flow Chart
5 = met
Referrals 0 = failed to meet
Includes where referrals should be made at appropriate points, includes management 2.5 = partially met
of patient refusal 5 = met
Follow-up 0= failed to meet
Includes timeframes for subsequent follow-up of lesions with high vs low suspicion at 4 = partially met
appropriate points 8 = met
Biopsy Results 0 = failed to meet
Mentions patient communication and includes pathways for various results of biopsy 1 = partially met
and related actions (may use part of BC Cancer flow chart for this) 2 = met
Overall Demonstration of Lesion Management 0 = failed to meet
Displays critical thinking, demonstrates proficient level of lesion management, presents 2.5 = partially met
information in logical/organized manner, includes citations & References 5= met
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Biopsy Flow Chart

REFERENCES:

1. Williams M, Poh CF, Hovan AJ, Ng S, Rosin MP [Internet]. Evaluation of a Suspicious Oral Mucosal Lesion. April 2008;[Cited 2024 Feb 2];
74(3). Available from: https://www.cda-adc.ca/jcda/vol-74/issue-3/275.pdf

2. BCCOHP: Informed Refusal to Consent [Internet]. Interpretation Guidelines: Informed Refusal to Consent. September 2013; [Cited 2024 Feb 2]
Available from: https://oralhealthbc.ca/wp-content/uploads/2022/08/02.02.025-IG-Informed-Refusal-to-Consent.pdf

3. BCCOHP: Guideline for Early Detection of Oral Cancer [Internet]. Guideline for the Early Detection of Oral Cancer in British Columbia. March
2008; [Cited 2024 Feb 2] Available from: https://oralhealthbc.ca/wp-content/uploads/2022/08/03.02.007-Oral-Cancer-Screening.pdf