Sir, during the current virus situation there is a real risk that patients with malignant lesions present late to specialist teams, potentially resulting in worsened outcomes. Telephone consultation is available to patients via their GDP and offers an opportunity to identify high risk lesions and organise their timely onward referral if appropriate. Strict triage is essential and must include screening questions relating to head and neck oral squamous cell carcinoma.

In 2015, Birur et al. found remote monitoring of potentially cancerous oral lesions by primary care practitioners to have improved early detection and ultimate diagnosis of oral cancer.1 A similar system could be adapted in the current health climate, with patients taking photos of lesions found in their own mouth (assisted perhaps by a household member) and emailing them to their dental practice for review. In order to ensure the oral cavity is imaged satisfactorily, perhaps video may be an option, online facilities whereby a practitioner could ask the patient to move their tongue, swallow, or improve the angle of view to enable more detailed assessment.

When a fast track referral is received by OMFS, it can be reviewed by an experienced member of the team. If the referring clinician is able to obtain any photographs from the patient, they may be used, in addition to an ENT UK validated telephone risk stratification system which enables an evidence-based risk assessment to be made.2 Ongoing management of potential cases, whilst challenging, can then be arranged according to this risk.

We implore dental professionals to continue their rigorous efforts to detect oral cancer, by asking patients to phone in to their practice if they detect unexplained oral ulceration which persists longer than three weeks, a persistent lump in their neck, or notice a red or white patch anywhere in the mouth. Additional red flag symptoms would include changes to the voice, unintended weight loss and pain or difficulty swallowing. Despite the current uncertainty, our duty to patients still involves aiding their referral to specialist services should it become necessary.