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Radiology/ct scan of jaw shows bone cancer?

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QUESTION: A ct scan radiology report done a month after a rather large squamous cell cancer mass was removed from my jaw area by MOHS surgery said, "There is a defect of the maxilla anteriorly and laterally on the right. This lucency may represent a lytic process or postsurgical."

How likely is it for squamous cell skin cancer to spread to bone?

What kind of specialist would be appropriate to see about this situation.  I went to an oncologist and he didn't look under the bandage or in my mouth or at the cd with the ct scan images.  He said it couldn't be cancer because he said *skin* cancer of squamous type didn't spread to the bone.  I wondered did he not like me questioning a fellow doctors work or what?

What would be the best way or ways to determine if the jawbone does have cancer?

ANSWER: John,

It is not common for the skin squamous cell carcinoma to involve bone.  However, whatever that area is needs to be explained asap. It can not be post surgical since no one cut through or curved out the maxilla. If someone did then you had much more extensive cancer in the first place that would not be treated with MOHS. did you have radiation treatment to the area?  is the area of the maxilla in general vicinity of previous cancer lesion?
The area in the maxilla may be caused by dental problem/decay as well.  If you have prior CT then someone needs to compare the area.  Radiation therapy if you had it, may cause necrosis of the bone.  or there is another process that needs to be addressed.
Sorry to hear about the oncologist who didn't do much for you...that is not right.
At this point I think you need to see ENT specialist but not just any ENT doctor, see ENT doctor who does cancer work in the face/neck. He will me the most appropriate expert for you.

Hope this helps. Feel free to follow up with me if you have a second.

Michael

---------- FOLLOW-UP ----------

QUESTION: Michael,

Thank you for the reply.  I haven't had any previous cancer there or any radiation therapy there.  But I did have teeth removed in that area a couple of years ago.

Do you have any thoughts on the efficacy of a bone scan as opposed to a biopsy or prior to a possible biopsy?

An ENT sounds right and I wish I had gone to one instead of an oncologist.  But what do you think of going to another MOHS qualified dermatologist to evaluate the ct scan as well as the all the reports on the surgery which I have obtained from the the surgeon?  Perhaps I should do both.  Thanks.



John

Answer
John,
Are you saying that your skin cancer was at a remote location to that region of the maxilla?
If so then it is possibly an area from your bad tooth that was pulled.  Of course, without images, I am just guessing...I would hold off on other tests and biopsies, until someone will make more sense of what that CT shows.  I would call the radiologist (or ask your doctor who referred you for the scan to call the radiologist) and ask him/her if that area could be consistent with prior tooth removal.  If you have trouble then plan B is to go to ENT so they can look into your mouth and examine the exterior and then correlate with CT scan.  I guess you can go to MOHS doctor as well, preferably who did your treatment the last time.   In fact, you are probably right, if you can go to the same doctor, I would do that first and then move to ENT if you have not settled it.

Michael

Radiology

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Michael K.

Expertise

Almost any kind of questions regarding any types of radiology exams, procedures, meaning of radiology reports etc...

Experience

12 year experience in the field of radiology

Organizations
American Society of Neuroradiology, Senior Member Society of Pediatric Radiology, Active Member

Publications
Radiology Seminars in pediatric neurology American Journal of Roentgenology American Journal of Neuroradiology

Education/Credentials
Board Certified in Diagnostic Radiology Additional Certificate of Qualification in Neuroradiology

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