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Clinical Review Lesson of the week

Digital examination for oral cancer

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7217.1113 (Published 23 October 1999) Cite this as: BMJ 1999;319:1113
  1. Ritu Gupta, senior house officer,
  2. Michael Perry, specialist registrar in maxillofacial surgery
  1. Maxillofacial Unit, Kings College Hospital, London SE5 9RS
  1. Correspondence to: Mr M Perry, Maxillofacial Unit, Royal Surrey County Hospital, Guildford, Surrey GU2 5XX

    All medical students are taught the importance of rectal examinations especially in patients with gastrointestinal and genitourinary symptoms. Digital palpation is an essential aspect of clinical examination as tumours are often not seen but can be felt by an examining finger.

    Although inspection of the mouth can provide many clues to underlying disease this may not always be the case with local disorders.

    Many cancers of the mouth, particularly in the early stages, manifest few symptoms many of which may be mistakenly attributed to benign causes. A high index of suspicion is therefore essential if malignant tumours are to be identified at a potentially curable stage. We describe three cases that emphasise the importance of performing a digital examination in all patients presenting with symptoms suggestive of oropharyngeal disease.

    Case reports

    Case 1—A 62 year old woman presented with a 3 week history of a “lump in [her] throat,” which she localised to the back of her tongue on the left side. No lesion was evident on inspection, especially mucosal ulceration or swelling, and the tongue moved freely. Palpation, however, indicated a large infiltrating indurated mass arising deep within the left posterolateral border …

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