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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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 ,,,.
  • Consideration of a suspected cancer pathway referral by the dentist if the lesion is consistent with oral cancer ,.
  • 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 ,.
  • 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 ,,.
  • 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 ,.

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

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