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Ask Dr. Heindel, D.V.M Your Own Question

Dr. Heindel, D.V.M
Dr. Heindel, D.V.M, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 330
Experience:  13 yrs experience as small animal veterinarian, including 2 yrs at a cat-only clinic.
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Formerly pink cat mouth is now black, pulled lip back a bit

Customer Question

Formerly pink cat mouth is now black, pulled lip back a bit and it's raw inside. This discoloration is clearly visible from the outside - a dime sized spot on his muzzle is mottled reddish/black under white fur.

Weight loss starting to be detectable, fist size patch of fur pulled at on one side, thumb sized lump underneath the area. Laying around more than a ten year old tom cat should, clingy. Sits in corner he has not previously frequented, facing the wall as if he has done something wrong.

Shows no sign of pain, drinking, going up/down stairs, no apparent changes in litter box.

Any idea? Cancer that's spreading was our first guess.
Submitted: 3 years ago.
Category: Cat Veterinary
Expert:  Dr. Heindel, D.V.M replied 3 years ago.

Dr. Heindel, D.V.M :

Hi, I'm Dr. Heindel. I'm going to try to assist you with your issue.

Dr. Heindel, D.V.M :

A mass inside the mouth of a cat is usually not good news. If it's pigmented, as you say, I lean toward melanoma, although it could be squamous cell carcinoma as well.

Customer :

I would not use the word 'mass' to describe this.

Customer :

First it was just a black spot on chin, then it spread to a dime sized patch outside, right on the tip. Last night we coaxed mouth open a tiny bit, formerly pink mouth is entirely black all over. There is part that is red. He has no difficulty eating so far as we can tell, constantly asks for food. When presented with wet he does go for all the liquid first, leaves solids in can, but will eat them in evening. I do have a photo of his mouth, not sure how to get it open without getting bit. He is pretty docile, just need instructions and way to send photo.

Dr. Heindel, D.V.M :

Okay, first question, is he an orange tabby? Because orange tabby cats develop dark spots on their gingiva (gums) and nose as they age.

Dr. Heindel, D.V.M :

Second, if you look in the toolbar right above where you type ... the 10th icon is a picture of a tree. Hover over that and you can upload a pic. I just learned this yesterday so I'm pretty excited about it! But, I found that my pic (a different one) was too big, so I had to reduce the image to make it smaller. I'll try now:

Full Size Image
Well, this one didn't need to be reduced apparently. Give it a go and we'll see if we can't get a pic for me to look at, okay?

Dr. Heindel, D.V.M :

TTYS,

Dr. Heindel, D.V.M :

Dr. Heindel

Customer :

Full Size Image

Customer :

So he is dark all over inside his mouth, it's obvious color change on his chin, and I can't get a shot but right in front his lower lip is weird, red, raw looking. Overall this just looks wrong ... it's kinda wet, kinda sloppy looking to me.

Customer :

The fist sized patch of fur is even more sparse today and there is a thumb sized lump at one end. He isn't bothering fur anywhere else on his body, it's just this one patch.

Dr. Heindel, D.V.M :

Great job!! You got it up! And when I enlarged it, I see that it's not a mass, it's just pigment. It's not uncommon for some cats to put down pigment (melanin) as they age. If his lower lip is swollen, he may have what we call eosinophilic granuloma complex - also know as rodent ulcers because they used to think a mouse bit the cat and the swelling was because of that. How long has this been going on?

Dr. Heindel, D.V.M :

I'm going to put my client handout about EGC here for you to read. If you can't print it, copy and paste it to a word doc.

Customer :

This is something that can be treated? What about his lump?

Dr. Heindel, D.V.M :

 



Feline Eosinophilic Granuloma Complex


 


What is feline eosinophilic granuloma complex?


Eosinophilic granuloma complex is a term used to describe three forms of skin lesions in cats: eosinophilic plaque, eosinophilic granuloma and indolent ulcers. . These lesions have a characteristic microscopic appearance due to the presence of eosinophils, which are a form of inflammatory cell. The term eosinophilic granuloma is derived from the presence of these cells.


 


What causes eosinophilic granuloma complex?


The exact cause of feline eosinophilic granuloma complex is not known. Research suggests that some form of allergic response may be involved (hypersensitivity reaction) in the majority of cases. This is more likely in cases that are recurrent. Other studies seem to indicate that the condition may at least be partially genetic or inheritable.


 


What are the symptoms of feline eosinophilic granuloma complex?


The most common site for these lesions is on the lips, especially the upper lips, where they appear as ulcers. They are sometimes referred to as "rodent ulcers” although this term is technically incorrect. The lesions range from small and barely noticeable ulcers to large and extensive ulcers with an obvious lip abnormality. Bleeding occurs from some lesions. Eosinophilic granulomas may also develop in the mouth, especially along the gums and palate, or on other areas of the body. When lesions form in other locations, they usually appear as bald patches with raised skin areas having a fleshy appearance rather than an ulcer. These types of lesions may also be referred to as eosinophilic plaques. Common sites are the hind legs and the stomach. The lesions can be large and may be itchy, since the cat frequently licks and even bites at the affected site.



How is eosinophilic granuloma complex diagnosed?


Diagnosis is based on your cat’s medical history and physical examination. Microscopic examination of a lesion (fine needle aspiration or biopsy and histopathology) is necessary to diagnose eosinophilic granulomas. The appearance of the characteristic lip ulcers is highly suggestive and biopsy may not be required initially. If lesions are located elsewhere on the skin or in the mouth, a biopsy is often recommended to rule out other diseases and conditions. Biopsy or fine-needle aspiration is a simple procedure that can be performed quickly and safely.


 


How is eosinophilic granuloma complex treated?


The most common treatment method for eosinophilic granuloma complex involves using corticosteroids. Corticosteroids can be given in a variety of different forms, but most often as injections or tablets. Treatment may last for weeks to months due to the fact that eosinophilic granulomas frequently recur and prolonged treatment will minimize the chance of recurrence. Side effects of corticosteroids are usually not significant in cats, but prolonged use can cause side effects such as an increase in weight.


 


There are numerous other treatments that may be used including other drugs, surgical removal of the lesions and cryosurgery or freezing of the lesions with liquid nitrogen while the cat is anesthetized. These treatments are sometimes recommended in recurrent cases. Some forms of eosinophilic granuloma complex are more difficult to treat. In cats with large skin lesions, surgery may be recommended early in the treatment course.


 


Flea and insect control is very important in the treatment of feline eosinophilic complex. This is due to the suspected hypersensitivity reaction cause of the condition. Insect bites can trigger an exaggerated immune response in affected cats, causing or worsening clinical signs.


 


Some cats respond to elimination or hypoallergenic diets, suggesting an underlying food allergy as the cause.


 


What is the prognosis for a cat diagnosed with eosinophilic granuloma complex?


Most cases respond well to medical treatment. Recurrence is common and requires life long intermittent treatment in many cases. Some cats that are severely affected will require more aggressive treatment and consultation with a board-certified veterinary dermatologist may be beneficial.


 


 








Dr. Heindel, D.V.M :

The answer to your question, can it be treated? YES!! A steroid inj. does the trick. Cats tolerate steroids very well. We typically use Depo-medrol and it can last up to 3 months. Some cats get this once a year, a few times a year, once every couple of years, or monthly. Since this is new, we can't know.

Customer :

We found a flea today examining him!

Customer :

So this could be treated with steroids?

Dr. Heindel, D.V.M :

The other thing is, there really is no substitute for a physical exam. By taking Scooby into the vet, you will have an experienced vet be able to do a complete, thorough exam. We can postulate here, but we could be way, WAY off base. Pictures can help, but there still are limitations. I think it's worth making that exam appointment and just addressing it with a physical exam! Your vet may know what this is upon first glance!!! Even if it is EGC, you'll need a vet to give the prescription. I'm happy to help you here, but I'm sure you understand the limitations of this situation. I cannot prescribe you medication.

Dr. Heindel, D.V.M :

EGC is treated with steroids. Finding the flea means he'll need to be on Frontline Plus for 2 consecutive months, as will any other pets in the home. The life cycle of the flea is 5 weeks, the product works for 4 wks, so treat for Jan. and Feb. Maybe he's having a flea allergy!

Dr. Heindel, D.V.M :

Don't settle for the OTC junk - they are harmful pesticides and often send cats to the ER with seizures! Frontline is very safe and very effective.

Dr. Heindel, D.V.M :

I know you guys are worried about him, but my gut is telling me this is not a big deal. I'm happy to hear it's not an "oral mass" - THAT is a big (bad!) deal. Older cats develop pigment deposits, like people - age spots!

Customer :

Thank you so much. Do we mention you by name if we write about this, or just mention the service? Scooby is rather famous, as far as cat's go ...

Dr. Heindel, D.V.M :

If you have no further questions for me at this time, can you please hit ACCEPT to close this from the open question board. However, should you have follow-up questions, I'm happy to answer, at no additional fee, and I'll answer just as soon as I can. You can find our thread under My Questions.

Dr. Heindel, D.V.M :

Good luck and have a great day!
Dr. Heindel

Dr. Heindel, D.V.M :

You are welcome to mention my name and/or Just Answer. Feel free to share the dialogue ... We know that owners are looking for answers for their pet - I cannot replace an exam or treatment from your vet, but I can share experience, impressions, and suggestions. Good luck to you!!!
Dr. H

Dr. Heindel, D.V.M, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 330
Experience: 13 yrs experience as small animal veterinarian, including 2 yrs at a cat-only clinic.
Dr. Heindel, D.V.M and 5 other Cat Veterinary Specialists are ready to help you
Customer: replied 3 years ago.

http://www.dailykos.com/story/2011/1/4/933270/-Comforting-Dying-Pets

FYI Scooby's human is Beth Becker - Netroots Nation board member, Pennsylvania Progressive Summit program chair, Netroots for the Troops board, advisor to the Congressional Progressive Caucus. DailyKos loves cats and his being sick was cause for a bit of a stir. We mentioned you and this service at the end of the story.
Expert:  Dr. Heindel, D.V.M replied 3 years ago.
Wow, that's a great blog! Please keep me apprised of his diagnosis - I am praying for EGC, as I am sure you are as well!!

Thanks for the mention. I am sending good thoughts your way!
Take care and good luck!

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