Sir, I share with you a recent experience highlighting the importance of referring unknown pathology, despite how benign it may appear.

A referral was received by our oral and maxillofacial surgery (OMFS) unit for a 93-year-old male with an asymptomatic swelling on the labial aspect of his lower lip. A routine dental examination with a new GDP had prompted a referral, highlighting a soft tissue lesion on the lower lip - query mucocoele.

The patient was duly assessed and reported the swelling was longstanding but causing no discomfort. Following examination, he was reassured the swelling was indeed consistent with a clinical diagnosis of mucocoele. An excision was organised due to concerns of trauma to the lesion whilst eating.

The histological findings however confirmed the lesion instead to be an angioleiomyoma: a very rare benign tumour of smooth muscle (vascular variant).1

The patient was subsequently reviewed and informed of the change in diagnosis. The surgical site showed good post-operative healing. He will be for review in six months to ensure no recurrence prior to discharge.

This case demonstrates how easily clinicians can be caught out as these lesions are often disregarded or ignored for their commonality. Whilst the patient reports no concerns, the often symptomless lesions can easily be overlooked at routine examinations under the guise of being monitored.

Given an angioleiomyoma arises from the smooth muscle of blood vessels, it is clear how trauma to such a lesion would have more serious consequences for the patient compared to trauma sustained to a mucocoele. Furthermore, differentials of angioleiomyoma include oral leiomyosarcoma, which as a malignancy is crucial to rule out.2

As such we urge our primary care colleagues to remain vigilant towards all abnormal findings in the oral cavity and refer persistent lesions for diagnosis. Also, we urge our secondary care colleagues not to underestimate lesions as was the case with us and this patient.