Vinay Naresh Mistry, Mohamed Imran Suida, Deborah Kirkham, Michael Wing Sung Ho
{"title":"一种非典型的、不愈合的口周病变。","authors":"Vinay Naresh Mistry, Mohamed Imran Suida, Deborah Kirkham, Michael Wing Sung Ho","doi":"10.1136/bmj.j3823","DOIUrl":null,"url":null,"abstract":"A 57 year old man was referred urgently to the oral and maxillofacial surgery clinic. He described a three month history of fatigue, recurrent sore throats, and a persistent “cold sore.” An irregular and indurated ulcer was present on the right oral commissure (fig 1⇓), and an ipsilateral swelling was palpable in the submandibular triangle (fig 2⇓). He had no relevant medical history. He drank little alcohol and was a non-smoker.\n\n\n\nFig 1 Irregular and indurated ulcer present on the right oral commissure\n\n\n\n\n\nFig 2 Ipsilateral swelling palpable in the submandibular triangle\n\n\n\n\n\n### 1. What are the most important differential diagnoses to consider?\n\n#### Short answer\n\nThe most important differential diagnoses to consider include herpes labialis, primary syphilis, and squamous cell carcinoma.\n\n#### Discussion\n\nPrimary syphilis should be considered alongside herpes simplex labialis if the symptoms do not resolve in 10-14 days.1 Association with other red flags such as induration, bleeding, and concurrent cervical lymphadenopathy should prompt fast track referral to the local head and neck oncology clinic. Malaise is a common feature of syphilis that would not normally be seen at an early stage of squamous cell carcinoma.\n\nCases of syphilis have risen dramatically in recent years. In the UK, USA, and other Western countries, this rise has been most marked in men who have sex with men, so taking a targeted sexual history is essential.2 Syphilis is classified …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j3823"},"PeriodicalIF":0.0000,"publicationDate":"2017-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j3823","citationCount":"3","resultStr":"{\"title\":\"An atypical, non-healing perioral lesion.\",\"authors\":\"Vinay Naresh Mistry, Mohamed Imran Suida, Deborah Kirkham, Michael Wing Sung Ho\",\"doi\":\"10.1136/bmj.j3823\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"A 57 year old man was referred urgently to the oral and maxillofacial surgery clinic. He described a three month history of fatigue, recurrent sore throats, and a persistent “cold sore.” An irregular and indurated ulcer was present on the right oral commissure (fig 1⇓), and an ipsilateral swelling was palpable in the submandibular triangle (fig 2⇓). He had no relevant medical history. He drank little alcohol and was a non-smoker.\\n\\n\\n\\nFig 1 Irregular and indurated ulcer present on the right oral commissure\\n\\n\\n\\n\\n\\nFig 2 Ipsilateral swelling palpable in the submandibular triangle\\n\\n\\n\\n\\n\\n### 1. What are the most important differential diagnoses to consider?\\n\\n#### Short answer\\n\\nThe most important differential diagnoses to consider include herpes labialis, primary syphilis, and squamous cell carcinoma.\\n\\n#### Discussion\\n\\nPrimary syphilis should be considered alongside herpes simplex labialis if the symptoms do not resolve in 10-14 days.1 Association with other red flags such as induration, bleeding, and concurrent cervical lymphadenopathy should prompt fast track referral to the local head and neck oncology clinic. Malaise is a common feature of syphilis that would not normally be seen at an early stage of squamous cell carcinoma.\\n\\nCases of syphilis have risen dramatically in recent years. In the UK, USA, and other Western countries, this rise has been most marked in men who have sex with men, so taking a targeted sexual history is essential.2 Syphilis is classified …\",\"PeriodicalId\":93911,\"journal\":{\"name\":\"BMJ (Clinical research ed.)\",\"volume\":\"358 \",\"pages\":\"j3823\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2017-09-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1136/bmj.j3823\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ (Clinical research ed.)\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmj.j3823\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ (Clinical research ed.)","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmj.j3823","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
A 57 year old man was referred urgently to the oral and maxillofacial surgery clinic. He described a three month history of fatigue, recurrent sore throats, and a persistent “cold sore.” An irregular and indurated ulcer was present on the right oral commissure (fig 1⇓), and an ipsilateral swelling was palpable in the submandibular triangle (fig 2⇓). He had no relevant medical history. He drank little alcohol and was a non-smoker.
Fig 1 Irregular and indurated ulcer present on the right oral commissure
Fig 2 Ipsilateral swelling palpable in the submandibular triangle
### 1. What are the most important differential diagnoses to consider?
#### Short answer
The most important differential diagnoses to consider include herpes labialis, primary syphilis, and squamous cell carcinoma.
#### Discussion
Primary syphilis should be considered alongside herpes simplex labialis if the symptoms do not resolve in 10-14 days.1 Association with other red flags such as induration, bleeding, and concurrent cervical lymphadenopathy should prompt fast track referral to the local head and neck oncology clinic. Malaise is a common feature of syphilis that would not normally be seen at an early stage of squamous cell carcinoma.
Cases of syphilis have risen dramatically in recent years. In the UK, USA, and other Western countries, this rise has been most marked in men who have sex with men, so taking a targeted sexual history is essential.2 Syphilis is classified …