P051 Odontogenic sinus tracts mimicking suspected cutaneous malignancy of the chin: a diagnostic pitfall

Abstract

Cutaneous lesions of the chin and lower face may arise from odontogenic sinus tracts but are frequently misdiagnosed as primary dermatological conditions or suspected malignancies. Misdiagnosis can result in ineffective antibiotic use, patient anxiety, inappropriate urgent services and delayed treatment. We highlight diagnostic pitfalls at the primary care–dermatology interface, including teledermatology, and present three cases of persistent chin lesions. We retrospectively reviewed three patients referred to dermatology under urgent 2-week-wait skin cancer pathways for persistent chin lesions. Data on clinical features, prior management, imaging, interventions and outcomes were analysed. Case 1 involved a 47-year-old woman with a persistent left-chin papule, initially treated as a pyogenic granuloma. The lesion resolved following root canal treatment of the lower-left central incisor. Case 2 is that of a 42-year-old woman with a right-chin nodule, managed in primary care with oral antibiotics and subsequently reviewed by teledermatology. Complete resolution occurred after apicectomy of the lower-right lateral incisor and sinus tract excision. Case 3 involved a 55-year-old man with a central ulcerated chin lesion, who received oral antibiotics in primary care and was assessed via teledermatology. Resolution followed apicectomy and excision of the fistulated tract. Persistent or nonhealing chin lesions referred for suspected skin cancer may be odontogenic. Early recognition in primary care, careful teledermatology assessment and timely referral to dentistry or oral and maxillofacial surgery prevents unnecessary antibiotics, biopsies and urgent referrals. Prompt lesion healing improves patient care and reduces strain on 2-week-wait pathways.