When to Biopsy an Oral Lesion: Tips From an Oral Pathologist | Dr. Ashley Clark

When should you biopsy a lesion, and how? Oral pathologist Dr. Ashley Clark explains why the old "wait two weeks" rule is out, when a scalpel beats a brush biopsy, and why you should never give steroids before you biopsy a suspected autoimmune lesion. She also covers laser vs. cold steel, punch biopsies, and proliferative verrucous leukoplakia (PVL), the gingival lesion that keeps coming back "benign" until it isn't.

In this episode:
- Why the two-week rule is out: biopsy suspicious lesions the same day
- Scalpel vs. brush biopsy, and what a brush biopsy can and can't tell you
- Diagnose, then treat: why steroids cause false negatives for pemphigus and pemphigoid
- How long a steroid holiday to take before a biopsy
- Laser vs. scalpel: when thermal damage ruins the diagnosis
- Punch biopsies, and why you don't need normal tissue (except with ulcers)
- PVL: the gingival leukoplakia with almost 100% malignant transformation
- Why benign hyperkeratosis still needs follow-up for 20 years
- Smokeless tobacco keratosis: when to biopsy
- Why your biopsies should go to an oral pathologist

📰 Plus dental news from November 2022: Massachusetts passes Question 2 on dental insurance, the ADA's proposed CDT code modifiers, and the ADA's Q3 report on the dental economy.

Dr. Ashley Clark is an oral and maxillofacial pathologist. At the time of recording she was interim associate dean for academic affairs and division chief of oral pathology at the University of Kentucky College of Dentistry. She serves on the professional boards of the Oral Cancer Cause and Digital Dental Notes, has won several teaching awards, has given more than 100 CE courses, and has authored over 40 publications and book chapters.

🙌 Special shout out to Q-Optics for making this episode possible!

Chapters:
0:00 Intro
0:29 Welcome
1:18 News: Massachusetts passes Question 2
3:00 News: proposed CDT code modifiers
6:42 News: the ADA's Q3 dental economy report
11:41 Meet Dr. Ashley Clark
13:11 How she got into oral pathology
16:09 Training to be an oral pathologist
18:47 "Fixing teeth is easy, diagnosis is not"
19:53 The two-week rule is out
20:33 Scalpel vs. brush biopsy
22:08 Incisional biopsies
22:57 Diagnose, then treat: steroids and false negatives
25:40 The hidden cost of a brush biopsy
27:43 How long a steroid holiday before a biopsy?
28:27 Laser vs. scalpel biopsies
29:19 Punch biopsy vs. wedge
30:26 You don't need normal tissue, except with ulcers
31:45 The strangest lesions she's seen
34:19 Five biopsies to get a cancer diagnosis
35:29 Proliferative verrucous leukoplakia (PVL)
38:08 Don't overlook gingival lesions
38:45 Send biopsies to an oral pathologist
39:20 How PVL is treated
41:47 When "benign" still needs follow-up
43:23 Hyperkeratosis: watch every 6 months for 20 years
44:19 Smokeless tobacco keratosis: when to biopsy
48:12 Thank you, Dr. Clark
49:56 Closing

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