- Email: [email protected]
Re: Destruction of molar roots by metastasis of multiple myeloma
British Journal of Oral and Maxillofacial Surgery (2005) 43, 89—90
LETTERS TO THE EDITOR
Re: Burns et al. Sir, We were interested to read the recent technical note by A. Burns et al.1 and commend them for a helpful solution to a clinical problem which is based on common sense. We have also found clinical photographs useful in the management of recurrent basal cell carcinoma that has indistinct margins. These margins need to be delineated at the time of surgical removal but there is a risk that when multiple skin sites are sampled they can become confused even when the best operative diagrams accompany the biopsy specimen to the histopathology laboratory. In order to carry out mapping biopsies of skin lesions we simply number the various sites on the patient’s skin using a standard surgical marker. With the patient’s prior consent a digital photograph is taken of the area (Fig. 1). The photograph clearly shows the specimen numbers on the skin and allows a copy to sent to the pathology laboratory if required. In addition a copy can be retained in the
Figure 1. Digital photograph allows a record for mapping of multiple skin sites prior to biopsy.
patient’s notes for discussion at a future clinic or multidisciplinary meeting.
References 1. Burns A, Adams J, Endersby S. Orientation of histopathology specimens. Br I Oral Maxillofac Surg 2004;42:64—5.
Ceri Hughes∗ Charles Perkins Cheltenham and Gloucester Oral & Maxillofacial Unit, Cheltenham General Hospital Sandford Road, Cheltenham GL537AN, UK ∗ Corresponding author. Tel.: +44 1752 777111 fax: +44 1752 763212 E-mail address: [email protected] (C. Hughes) Available online 27 October 2004 doi:10.1016/j.bjoms.2004.08.025
Re: Destruction of molar roots by metastasis of multiple myeloma Sir, I am a regular reader of your journal and want to congratulate you and your team for your efforts in publishing the journal with good articles that really help in clinical practice. The journal also provides a medium by which we can interact with other specialists and practitioners. The short communication Destruction of molar roots by metastasis of multiple myeloma was interesting.1 The authors considered the diagnosis of multiple myeloma but gave no evidence (such as histological reports) to support their diagnosis. Other lesions that cause resorption of roots cannot be therefore excluded. Resorption of root signifies only that the lesion is long standing or that it is exerting pressure on the roots. I am not sure whether a diagnosis can be made on the basis of resorption
0266-4356/$ — see front matter © 2004 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
90 of roots alone, as in this paper. Patients with multiple myeloma can have systemic symptoms, and other investigations such as estimation of Bence Jones protein should be made. There is no mention of these. The authors stated that there were metastases in the jaws that caused the root to resorb, but no investigations were done to rule out metastases in other parts of the body and skull. Is it possible that the diagnosis was solitary plasmacytoma?
LETTERS TO THE EDITOR
Reference 1. Anacak Y, Kamer S, Donmez A, Haydaroglu A. Destruction of molar roots by metastasis of multiple myeloma. Br J Oral Maxillofac Surg 2002;40:515.
Ajit Auluck Department of Oral Medicine and Radiology Manipal College of Dental sciences, Manipal Karnataka, 576104, India Tel.: +91 820 2571201; fax: +91 820 2571966 E-mail address: [email protected] doi:10.1016/j.bjoms.2004.08.012
LETTERS TO THE EDITOR
Re: Burns et al. Sir, We were interested to read the recent technical note by A. Burns et al.1 and commend them for a helpful solution to a clinical problem which is based on common sense. We have also found clinical photographs useful in the management of recurrent basal cell carcinoma that has indistinct margins. These margins need to be delineated at the time of surgical removal but there is a risk that when multiple skin sites are sampled they can become confused even when the best operative diagrams accompany the biopsy specimen to the histopathology laboratory. In order to carry out mapping biopsies of skin lesions we simply number the various sites on the patient’s skin using a standard surgical marker. With the patient’s prior consent a digital photograph is taken of the area (Fig. 1). The photograph clearly shows the specimen numbers on the skin and allows a copy to sent to the pathology laboratory if required. In addition a copy can be retained in the
Figure 1. Digital photograph allows a record for mapping of multiple skin sites prior to biopsy.
patient’s notes for discussion at a future clinic or multidisciplinary meeting.
References 1. Burns A, Adams J, Endersby S. Orientation of histopathology specimens. Br I Oral Maxillofac Surg 2004;42:64—5.
Ceri Hughes∗ Charles Perkins Cheltenham and Gloucester Oral & Maxillofacial Unit, Cheltenham General Hospital Sandford Road, Cheltenham GL537AN, UK ∗ Corresponding author. Tel.: +44 1752 777111 fax: +44 1752 763212 E-mail address: [email protected] (C. Hughes) Available online 27 October 2004 doi:10.1016/j.bjoms.2004.08.025
Re: Destruction of molar roots by metastasis of multiple myeloma Sir, I am a regular reader of your journal and want to congratulate you and your team for your efforts in publishing the journal with good articles that really help in clinical practice. The journal also provides a medium by which we can interact with other specialists and practitioners. The short communication Destruction of molar roots by metastasis of multiple myeloma was interesting.1 The authors considered the diagnosis of multiple myeloma but gave no evidence (such as histological reports) to support their diagnosis. Other lesions that cause resorption of roots cannot be therefore excluded. Resorption of root signifies only that the lesion is long standing or that it is exerting pressure on the roots. I am not sure whether a diagnosis can be made on the basis of resorption
0266-4356/$ — see front matter © 2004 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
90 of roots alone, as in this paper. Patients with multiple myeloma can have systemic symptoms, and other investigations such as estimation of Bence Jones protein should be made. There is no mention of these. The authors stated that there were metastases in the jaws that caused the root to resorb, but no investigations were done to rule out metastases in other parts of the body and skull. Is it possible that the diagnosis was solitary plasmacytoma?
LETTERS TO THE EDITOR
Reference 1. Anacak Y, Kamer S, Donmez A, Haydaroglu A. Destruction of molar roots by metastasis of multiple myeloma. Br J Oral Maxillofac Surg 2002;40:515.
Ajit Auluck Department of Oral Medicine and Radiology Manipal College of Dental sciences, Manipal Karnataka, 576104, India Tel.: +91 820 2571201; fax: +91 820 2571966 E-mail address: [email protected] doi:10.1016/j.bjoms.2004.08.012