22
INSCRIPTIONS
| Journal of the Arizona Dental Association, June-July 2013
GUEST EDITORIAL
It has been a couple years since I last discovered oral
cancer in one of my patients. Statistically, I am way be-
hind on what I should have found, although I religiously
do an oral cancer screening on patients with every exam
I do. I was fortunate to be selected for a short residency
at the Fox Chase Cancer Center in Philadelphia upon
graduation from dental school in May 1983. It was only
two months long, but all I saw during that time were
head and neck cancer patients.
In those days, it was all about survival. Many of the
patients looked like they had come in second place in a
chainsaw fight. As you know, the vascularity of the head
and neck area is an ideal location for cancers to grow
and spread, and also metastasize. Pedicle grafts of chest
tissue finessed up through the upper chest structures
to be used to rebuild radically-resected tongues was a
relatively new approach thirty years ago. And fortu-
nately, the techniques have continued to improve to help
restore some degree of normalcy to these patients.
Coincidentally, the day I began writing this article, I
referred a patient to a local oral surgeon. The report just
came back positive for squamous cell carcinoma. To
make matters more difficult, the patient has a significant
amount of dementia, of some type. He lives indepen-
dently, has no transportation, and really has no concept
of the difficult and convoluted path that now lies before
him. He has a brother who spends two- or three-
month periods with him every year.
His brother brought him into our office just days before
departing for Illinois. Unfortunately, the patient’s brother
is only slightly more lucid than he. However, there is
a slender ray of sunshine: A woman who is some sort
of superintendent at his apartment is willing to aid in
getting this journey started. It is difficult for a patient
with a sound support system and adequate transporta-
tion to navigate these waters. I can only hope we get his
treatment facilitated. The oral surgeon has been a great
resource. My thanks go out to Dr. Robert Buch for his
assistance. Time will tell if our efforts will be successful,
but the reason I am writing this column is to encour-
age all of you to not stop at referral to the oral surgeon.
Most patients do not have medical backgrounds and
can be overwhelmed by the intricacies of the treatment
pathway. We can help them. It may not be a profitable
endeavor, but it yields far more important rewards than
those of a monetary nature.
The case that I referenced at the beginning was a very
close friend of mine. I asked his permission to share
his experiences in pursuit of treatment. When I saw the
lesion in my friend’s mouth, I knew it was malignant. I
advised him to run, not walk, to the oral surgeon for
confirmation. He received confirmation. Recognizing
that a neck resection was going to be necessary, the oral
surgeon referred him to an ENT surgeon. This is where
the wheels came off. The ENT surgeon insisted on do-
ing his own biopsy, which came back negative. He called
the patient and advised, “We will check it in six months.”
Upon hearing this news, the patient was elated—right
up until he talked with me. Rather than turning a blind
eye to a lesion I felt was malignant, I got him an ap-
pointment with a different ENT surgeon, and it came
back malignant. I have absolutely no doubt that if I
had not stayed involved, I would not be making him an
implant-retained partial denture/obturator. I would have
been making plans to attend his funeral.
My point is, please do not forget the patient after the
first referral has been made. I feel it is your responsibility
to follow any oral cancer case to its eventual conclusion.
Officially, April was oral cancer awareness month, but
for us every month is oral cancer awareness month.
It only takes a few seconds to look.
CADS Past President
Martin J. Margetis, DDS
Dr. Marty Margetis practices
general dentistry in Sun City.
He is a past CADS President.
WorthaFollowUp
Had I not stayed involved,
mypatientwouldnolongerbearound
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