What investigations are recommended before referring a patient with suspected oral cancer?

Recommended investigations before referring a patient with suspected oral cancer include:

• An urgent clinical assessment by a dentist if the patient has a lump on the lip or in the oral cavity, or a red or red and white patch consistent with erythroplakia or erythroleukoplakia, to confirm suspicion of oral cancer ¹,³,⁴,⁵.
• Consideration of a suspected cancer pathway referral by the dentist if the lesion is consistent with oral cancer ¹,³.
• For unexplained ulceration in the oral cavity lasting more than 3 weeks, or a persistent and unexplained lump in the neck, a suspected cancer pathway referral should be considered without delay ¹,³.
• In cases of unexplained or atypical gingival enlargement, consider urgent investigation for possible leukaemia with a very urgent full blood count within 48 hours before referral, as this can mimic oral cancer presentations ¹,⁴,⁵.
• If there is a strong suspicion of oral cancer and/or delay in accessing a dentist is likely, clinical judgement should be used to refer urgently via a local suspected cancer referral pathway or seek immediate specialist advice from oral medicine or oral and maxillofacial specialists ⁴,⁵.

Routine imaging or blood tests are not explicitly recommended before referral unless there are atypical features suggesting other diagnoses (e.g., leukaemia) ¹,⁴. The primary investigation is clinical assessment by a dentist to confirm the need for urgent suspected cancer referral ¹,³.