At a Glance - Dental sinus versus basal cell carcinoma

Contributed by Dr Jean Watkins, a sessional GP in Hampshire

Dental Sinus
dental sinus

Aetiology

  • Sinus track that drains on to the face or neck from a dental infection.
  • More commonly associated with mandibular teeth, less often the maxillary teeth.

Presentation

  • Pimple, nodule, ulcer or indurated cystic area.
  • Drainage usually occurs on the submandibular, submental regions to the chin or sometimes the cheek or naso-labial fold.
  • Often no problems of toothache.
  • Affected tooth may be tender on percussion.
  • Sinus track may drain onto the face but more usually into the mouth.
  • Dental problem may have occurred years earlier and been forgotten by the patient.

Management

  • Dental X-ray to identify the source of the problem.
  • Extraction of the tooth should quickly lead to resolution of the sinus.
  • Antibiotics if the patient is ill with fever or has lymphadenopathy.

Basal Cell Carcinoma (BCC)
Basal cell carcinoma lesions may ulcerate

Aetiology

  • Common in the fair skinned, on sun-exposed skin or following exposure to X-rays or arsenic.
  • More common in the elderly, but may affect sun worshippers at a younger age.
  • Genetic factors e.g. Gorlin syndrome.

Presentation

  • BCCs may be nodular, superficial with slowly growing irregular pink scaly plaques, pigmented or morphoeic with sclerosis that may resemble a waxy scar.
  • Telangiectasia may run across the lesion.
  • Lesion may ulcerate.
  • If stretched a raised, rolled, pearly ring may be obvious.

Management

  • Treatment depends on size and site of the lesion(s).
  • Good prognosis if adequately treated.
  • Shave, curettage and cautery may be sufficient for small lesions.
  • Biopsy to confirm diagnosis or excision and histology.
  • Imiquimod three to five times a week for six to 16 weeks.
  • Radiotherapy.
  • Future protection from the sun with hats, clothing and sunscreen.
  • Watch for the development of further lesions.

 

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