Sir, I am concerned by the advice given in Scully and Felix's recent update article on oral cancer regarding biopsies of suspected malignancies in general practice (BDJ 2006; 200: 13–17).

I cannot emphasise too strongly that I consider this advice inappropriate and potentially misleading. The over-riding principle is urgent referral of suspicious oral lesions to specialist maxillofacial surgery, oral medicine or head and neck cancer units where all patients with suspected oral cancer should be seen for clinical assessment prior to any interventional or biopsy procedures being carried out. Non-specialist biopsies delay referral, are often inadequate for diagnostic purpose and may confuse or obscure important clinical features. In some cases, smaller lesions have actually been excised leading to considerable patient assessment difficulties, ultimately compromising patient care. Ideally, the clinician with ultimate management responsibility for the cancer patient should be the one to carry out assessment and biopsy. All head and neck cancer units see patients with suspected malignancy within two weeks (the 'two week suspected cancer referral guideline') and the situation as suggested by Scully and Felix whereby 'a specialist opinion is not readily accessible' should not arise in modern clinical practice.

Professors Scully and Felix respond: We thank Professor Thompson for his interesting comments and opinion. As we have stated, we believe that the GDP should be competent and have confidence to undertake this procedure. In regard to the two week referral guideline this relates to the UK and as the readership of the BDJ is not restricted to the UK there are undoubtedly areas where 'a specialist opinion is not readily accessible'.