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Dr. Das, MD
Dr. Das, MD, Doctor
Category: Medical
Satisfied Customers: 2218
Experience:  MBBS, MD, with wide experience in all aspects of medical treatment, including cancer therapy.
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Hello, are there any ENTs on here?

Customer Question

Hello, are there any ENT's on here?
Submitted: 11 months ago.
Category: Medical
Expert:  Dr. Das, MD replied 11 months ago.
Hello,

I am an ENT specialist. Please ask your question.
Customer: replied 11 months ago.
Hi,
Here is some background info. I've had 3 papillomas in my mouth area in the last 7 months. The first I coughed up not sure from where but I think my throat, that was benign on pathology. The second was on front of uvula this past June and was moderate dysplasia and was removed in office. The 3rd was removed surgically because it was on back was uvula, the surgery was September 10, 2013. That was benign. So last night i had some mild pain in my throat on the left side and i went to an ENT today, the doctor took a look and said it looked like an ulcer. I've never in my life that I remember had an ulcer in my throat. Are these things typically benign, can a doctor tell the difference between an ulcer and some other type of growth? I've heard before that ulcers can be a sign of mouth or throat cancer depending on where the ulcer is located of course.

Thanks for your help.
Expert:  Dr. Das, MD replied 11 months ago.
Thank you for the added information.

Most ulcers in the throat are benign - they occur due to infection and inflammatory reactions. An ulcer may be suspected that it is benign by its appearance - A benign growth is usually painful, a malignant growth is not painful. A benign ulcer feels soft to the tough and is not fixed to the underlying tissues. A malignant is hard or firm and seems to be fixed to the underlying tissues. A biopsy is, of course, confirmatory.

Yes, ulcers can be a sign of a throat cancer but these are usually ulcers which do not heal for longer than 3-4 weeks even with treatment.

In your case, your symptoms - pain as well as recent appearance of the ulcers - suggest s benign ulcer.

Dr. Das, MD, Doctor
Category: Medical
Satisfied Customers: 2218
Experience: MBBS, MD, with wide experience in all aspects of medical treatment, including cancer therapy.
Dr. Das, MD and 4 other Medical Specialists are ready to help you
Customer: replied 11 months ago.
Thanks for the info. Yes, I just had my two week post op visit with my ENT and he did another flexible endoscopy this past Tuesday and there was no ulcer. I did drink some scalding hot tea yesterday afternoon, can that cause an ulcer?
Expert:  Dr. Das, MD replied 11 months ago.
Yes, anything very hot can cause an ulcer - the upper mucus membrane can get burnt and eroded away causing a shallow painful ulcer. It is very likely that this is what has happened to you.

Customer: replied 11 months ago.
Thank you.
Customer: replied 11 months ago.
If I may ask one more question please. In your experience, of the patients you have had with papillomas, have you had any that ended up with throat or oral cancer done the road?
Customer: replied 11 months ago.
Down the road, not done
Expert:  Dr. Das, MD replied 11 months ago.
Lana,

So far, i have had only 1 patient who developed cancer after having had a papilloma removed - but that was because he failed to turn up for a regular yearly checkup. Patients who undergo yearly checkups do not go on to develop cancer since the papillomas are diagnosed at an early stage and removed.

Customer: replied 11 months ago.
Pathology of the second papilloma was moderate dysplasia with HPV cellular changes. I have never smoked, don't drink and don't chew tobacco. I have had CML at age 19 with bone marrow transplant. No radiation for transplant in 1994 but had chemo. Sorry, giving more background info. Last question- did this patient have an actual cancerous papilloma or just some other type of throat/mouth cancer. I've read it's so rare to even have a dysplastic papilloma and even rarer to have a cancerous one.
Expert:  Dr. Das, MD replied 11 months ago.
It was a squamous cell carcinoma but no evidence of a papilloma was found. We were not sure if a papilloma had turned cancerous or it was a squamous cell carcinoma which had developed de novo without a papilloma but it was probably the latter.

Dr. Das, MD, Doctor
Category: Medical
Satisfied Customers: 2218
Experience: MBBS, MD, with wide experience in all aspects of medical treatment, including cancer therapy.
Dr. Das, MD and 4 other Medical Specialists are ready to help you
Customer: replied 9 months ago.

Hi again and happy holidays. I went to the ENT for my every two month check at the end of November. Everything was fine and no new papillomas. I seem to frequently get these little growths on the insides of my cheeks around the linea alba. They almost look like little painless ulcers and are usually gone within 24 - 48 hours. Today I noticed one along the other side of my inside cheek, also seems to be around the linea alba but this one is a little more yellowish in color and is protruding moreso than what I've seen in the past. I started thinking, perhaps this is another papilloma. It is very small but I'm wondering if this is the beginning of another papilloma. Have you seen anything like this before? I'm going to post a photo and I have circled the area.



Customer: replied 9 months ago.

I then later gently rubbed the growth with my fingernail and it came off. This is what it looks like now but this area that's left still feels somewhat hard at the tip.


 



 

Customer: replied 9 months ago.

If this were a papilloma, is it likely I could have broken part of it off? And if yes, if it regrows should I assume it's a papilloma?

Expert:  Dr. Das, MD replied 9 months ago.
Lana,

This does not look like a papilloma - and no, if this had been a papilloma, you would not have been able to break a bit off.

This looks more like a fungal growth or dead skin produced due to a cheek bite. It can also be due to irritation by some type of food.

I doubt that it will regrow - and even if it does, a papilloma is unlikely.

Dr. Das, MD, Doctor
Category: Medical
Satisfied Customers: 2218
Experience: MBBS, MD, with wide experience in all aspects of medical treatment, including cancer therapy.
Dr. Das, MD and 4 other Medical Specialists are ready to help you
Customer: replied 9 months ago.
I don't remember biting my cheek but of course it could have happened in my sleep. The piece I broke off yesterday, today looks a little bigger than it did on the second photo I posted (after I broke off the piece). When I touch the tip of it, it's hard.

The 3 papillomas I had, the first I actually coughed up after sensation for many months of something stuck in the throat, the last two grew off the uvula. Not to say it can't move to the cheek?

If it regrows within a couple days, would that point to fungal growth, skin tag, salivary gland stone or likely something more sinister?

Expert:  Dr. Das, MD replied 9 months ago.
Customer

Papillomas generally do not grow fast - they are slow growing tumors. If it is looking larger within a day or two of breaking off, it is unlikely to be a papilloma. It is more likely to be a fungal growth.

But fungal growths are generally not hard. If the tip of the bump is hard, then this could be a papilloma. Papillomas do grow on the inside of the cheek, generally as a result of infections by the HPV virus, types HPV-6 and HPV-11. These are noncancerous and do not become cancerous growths. They do not need treatment unless they cause pain or cause difficulty in eating.

I do not think you have cause for worry.
Customer: replied 9 months ago.
One follow up question please. Papilloma coughed up in Feb 2013 (stuck in throat sensation) was benign. Mid June 2013 papilloma on uvula had moderate dysplasia. Removed in office. Small third papilloma on back side of uvula removed was benign. You mention two HPV subtypes. If a papilloma shows moderate dysplasia, does this mean I likely have a subtype more known to cause cancer versus one that just causes warts? I'm just asking in general terms, I know you of course can't tell me what subtype I have.
Expert:  Dr. Das, MD replied 9 months ago.
Low risk subtypes of HPV can also rarely cause dysplasia - usually other cofactors like chronic irritation (smoking, spicy foods) inflammation, infection etc are also present which help the dysplastic changes to develop.

In your case, since you have had two benign papillomas and one with moderate dysplasia, the chances are that you have a low risk subtype.
Dr. Das, MD, Doctor
Category: Medical
Satisfied Customers: 2218
Experience: MBBS, MD, with wide experience in all aspects of medical treatment, including cancer therapy.
Dr. Das, MD and 4 other Medical Specialists are ready to help you
Customer: replied 9 months ago.
Thank you. Also, by the way, the growth on my cheek was there this morning but about 10 hours later it is now gone :-)

Thanks again.
Expert:  Dr. Das, MD replied 8 months ago.
Customer

You are welcome. I am glad the growth is gone now - evidently not a papilloma then :-)
Customer: replied 8 months ago.

Hi Doctor,
I broke off the tip of the growth on the inside cheek about two weeks ago, it completely healed, even the little very small leftover raised area healed. It was fine for about one and a half weeks and then late last week, the area started to protrude again, the same as before with the small protruding hard tip just at the end.


 


Last night I again rubbed it with my fingernail and the very tiny growth area broke off again after several seconds (no blood). The best way to describe it, is it looks like almonst one of those yellow-ish tonsil stones except it was so small, maybe the size of the tip of a pen. I'm sure it would have grown larger had I not broken it off again.
Does this support more that its a papilloma, given the fact that it came back? I have an appointment in a couple weeks with the ENT but I am concerned.
Thank you.

Expert:  Dr. Das, MD replied 8 months ago.
Yes, since the growth has come back, the chances of this being a papilloma has increased. Papilloma's do sometimes tend to recur in the same place.
Dr. Das, MD, Doctor
Category: Medical
Satisfied Customers: 2218
Experience: MBBS, MD, with wide experience in all aspects of medical treatment, including cancer therapy.
Dr. Das, MD and 4 other Medical Specialists are ready to help you
Customer: replied 8 months ago.

Hi Dr. Das,


Friday morning I woke with a strange sensation on my upper right mouth, I would not call it pain, more like the sensation you get from swelling. Here is a photo of what I saw, I circled the area. You can see also the area underneath perhaps looks swollen when compared to the other side. I'm very concerned about this sense I had leukemia almost 20 years ago.....my concern is lymphoma now. I read painless swelling is often a symptom of malignancy....what are your thoughts about this picture?


 


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Customer: replied 8 months ago.

Also, here is a photo I found of something that I thought looked similar online along with description.


 


Submucosal mass on the right hard palate, near the junction of the hard and soft palates. A painless swelling of the palate is the most common presenting symptom for tumors of the palatal minor salivary glands.


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Expert:  Dr. Das, MD replied 8 months ago.
Yes, you do seem to have a bump in that region. Since it has become apparent only in the last 2-3 days, this is likely to be a swelling of a minor salivary gland. Minor salivary glands are present in many locations in the hard palate and can get irritated and swollen by pressure from hard food, very hot food, infections etc.

Considering that you have noticed the mass very recently, I doubt that this is a tumor - benign or malignant.

But you do need to get this checked out by an ENT specialist.



Customer: replied 8 months ago.
Thank you, just to make sure, only the first pic is of my mouth, not the second black and white, that black and white is a pic I found on Internet. You are commenting on my pic which is the first one in color?
Expert:  Dr. Das, MD replied 8 months ago.
Yes, I am commenting on the colored photo - the first one which is yours. The swelling seems to be very minimal, like something which can occur after a mild irritation of the mucus - not like a tumor at all.

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