Dentistry — Referral to OMFS for a Suspicious Oral Lesion
A general dental practitioner refers a 63-year-old man with a non-healing left lateral tongue ulcer, confirmed risk factors, and clinical features suspicious for malignancy to an oral and maxillofacial surgeon for urgent biopsy. The proficient challenge is selecting the clinical features that support urgent referral while cutting the extensive social and medical background.
Letter type
Referral
Write to
Oral and Maxillofacial Surgeon
Target length
200–230 words
The case notes
Patient: Mr Charles Doyle, 63 years old; retired builder
Lesion: Left lateral tongue ulcer: 1.5 cm, irregular rolled indurated margins, red and white component (erythroleukoplakia); present for 8 weeks; not resolving
Symptoms: Painless; no bleeding; patient noticed it himself incidentally; no dysphagia, no trismus, no neck lump reported
Risk factors: Smoker 40 pack-years; alcohol 35 units/week; no HPV vaccination history; previous mild dysplasia (right buccal mucosa, 2019, excised, resolved — histology confirmed low-grade)
Lymph nodes: Left level I/II lymphadenopathy — single node 1.5 cm, firm, non-tender on palpation
Action taken: Photograph taken; documented; patient advised urgently of the need for specialist assessment; dental X-ray clear; no adjacent tooth pathology that could explain the lesion
Not done and why: No biopsy attempted by GDP — incisional biopsy of suspected malignancy in primary dental care is outside GDP scope in this region; also preferred not to disrupt the lesion before specialist assessment
Social history (partial): Retired, lives alone, has a daughter; drives; not depressed; hobbies: fishing and darts
Task: Write an urgent referral letter to the oral and maxillofacial surgery department, naming the specific clinical features that justify urgent referral and requesting biopsy.
Writing task
Write an urgent referral letter to the oral and maxillofacial surgery department, naming the specific clinical features that justify urgent referral and requesting biopsy.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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The lesion characteristics: 1.5 cm, left lateral tongue, irregular rolled indurated margins, erythroleukoplakia, 8 weeks non-healing
These four features — location, size, margin type, colour change, and duration — are the clinical descriptors that tell the surgeon this is a suspicious lesion requiring urgent biopsy. Every one must be present.
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The left level I/II lymphadenopathy: single node, 1.5 cm, firm, non-tender
Regional lymphadenopathy adjacent to a suspicious oral lesion is a significant finding that upgrades the urgency. The surgeon needs this to understand potential nodal involvement before the appointment.
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The risk factors: 40 pack-year smoking history and 35 units/week alcohol
These are the two most significant risk factors for oral squamous cell carcinoma. Combined with the clinical picture, they complete the justification for urgent rather than routine referral.
Leave out
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The social history: retired, lives alone, daughter, hobbies
Not relevant to the OMFS referral. None of this information changes the surgeon's decision about when to book or what to biopsy.
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The previous buccal mucosa dysplasia history beyond a brief mention
Relevant context in one clause: 'previous low-grade dysplasia right buccal mucosa (2019, excised, resolved)'. The histology report is in the patient record; the OMFS referral notes the history, not the pathology detail.
Criterion in focus · Purpose
An urgent oral cancer referral must communicate urgency in the opening sentence — not the third paragraph. 'I am writing to refer Mr Doyle urgently for assessment and biopsy of a suspicious oral lesion with features concerning for malignancy' establishes the clinical priority immediately. A letter that describes the lesion at length before stating the urgency makes the reader decide for themselves; the referral must do that work for them.
Now write the letter — and find out what is blocking your Grade B
Write a 200–230 words referral letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.