When to biopsy: the two-week rule

What if the “wait and see” approach to suspicious oral lesions is putting patients at risk? In this episode, Dr. Paras Patel, an oral maxillofacial pathologist based in Texas, joins us to challenge outdated thinking and share a more proactive, data-driven approach to early detection and prevention. We begin with a key shift in the field: moving from the term ‘potentially malignant lesions’ to ‘precancerous lesions’, and what that change signals about risk, responsibility, and intervention. Dr. Patel unpacks how evolving diagnostic criteria, new treatment pathways, and better follow-up protocols are changing outcomes. He explains why he favors a two-week monitoring window for leukoplakia, how non-traditional risk factors like HPV and iron deficiency come into play, and why there is no single pathway to disease. The conversation also explores how biomarkers, advanced testing, and even AI can support clinicians in tracking change over time and making more informed decisions. Finally, Dr. Patel shares practical guidance on managing ulcers and tissue abnormalities and why consistent follow-up is critical, even after a patient has been referred.

Key Points From This Episode:

• Updated terminology, from ‘potentially malignant lesions’ to ‘precancerous lesions’.
• How the field has evolved through updated criteria, new treatment options, and more. 
• How Dr. Patel approaches follow-up to protect patients from developing cancer.
• Developments in pathology and treatment methods. 
• Why Dr. Patel favors a two-week period to monitor leukoplakia. 
• Non-traditional risk factors, including HPV and iron deficiency. 
• Understanding the multiple pathways to this kind of pathology. 
• Leveraging a variety of biomarkers and tests for direction as a clinician. 
• How AI can support this data collection process. 
• What Dr. Patel recommends for navigating ulcers and tissue during surgery.
• The platinum-based therapy he has been using with great results.
• Why follow up protocol is so important.

Links Mentioned in Today’s Episode:

Dr. Paras Patel on LinkedIn — https://www.linkedin.com/in/paras-patel-6023a7a1/ 

Dr. Paras Patel on ResearchGate — https://www.researchgate.net/scientific-contributions/Paras-B-Patel-2158422405
Center for Oral Pathology — https://www.centerfororalpathology.com/
Oral Diagnostics SDFW — oraldiagnosticsdfw@gmail.com
WHO Oral Epithelial Dysplasia: Classifications — https://pmc.ncbi.nlm.nih.gov/articles/PMC6503768/
Yen-Chen Kevin Ko on LinkedIn — https://www.linkedin.com/in/yen-chen-kevin-ko-561469115/
Glenn Hanna on ResearchGate — https://www.researchgate.net/scientific-contributions/Glenn-J-Hanna-2006701454
Alessandro Villa on LinkedIn — https://www.linkedin.com/in/alessandrovilla-oralmedicine/
Nivolumab for Patients With High-Risk Oral Leukoplakia — https://pubmed.ncbi.nlm.nih.gov/37971722/
 MD Anderson — https://www.mdanderson.org/ 

Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ 

Everyday Oral Surgery on Instag