As with any dental procedure, clinicians vary ‘in their surgical interests and skills. Some dentists are- adept and comfortable in performing almost any biopsy on their patients, whereas others refer all lesions. This variation
has as much to do with’ personal preferences as it does with level of skills. However, the dentist may use certain criteria to determine which biopsies to perform personally and which to refer. These can be summarized into the
following categories.
Health of Patient
Dentists frequently encounter patients who have systemic condi,tions or disease processes that make any surgical treatment either difficult to perform or a hazard to the patient’s health. Several system it conditions discussed in Chapters 1 and 2 complicate routine surgical procedures. If the dentist feels uncomfortable about or unprepared for managing patients who require special medical precautions, referral should not be delayed.

Surgical Difficulty
Biopsies vary in surgical difficulty, If any of the basic surgical principles outlined in Chapter 3 (e.g., access, lighting, anesthesia, tissue stabilization) are problematic to achieve in a given patient, the biopsy procedure is more
complicated. Similarly, as the size of the lesion increases, , as its position encroaches on normal anatomic structures, and as its potential for surgical complications (e.g., bleeding) increases, so does the difficulty of biopsy. Each dentist must decide whether the indicated biopsy is within
the general scope of his or her surgical skills. If not it should be referred.

Potential for Malignancy
The dentist who suspects malignancy has two choices. First, a biopsy can be performed after a thorough clinical examination, including examination of regional lymph nodes. Secondly, the patient can be referred before biopsy to a clinician who can treat the patient definitively in the event that the lesion is malignant. This latter choice may provide better service if the clinician who treats the patient definitively can see the patient  mmediately. It is much easier for this clinician to evaluate the lesion thoroughly before surgical manipulation. Biopsy can distort
the lesion locally and produce palpable, inflamed lymph nodes. Allowing the clinician to evaluate the patient before biopsy may improve the initial data base and allow a more accurate diagnosis-and formulation of treatrnent. However, if a dentist works in an area where the patient
must travel a long distance to see a clinician who can provide definitive treatment or the clinician -cannot be seen for several days, biopsy should not be delayed.

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