Our diagnostic view of bone lesions identified three main themes:
- inflammatory (including bone infections) and other non-neoplastic lesions;
- benign neoplastic lesions (benign lumps);
- malignant neoplastic lesions (bone cancers).
A similar subdivision can be made in terms of treatment of bone lesions.
For infections, inflammatory and other non-neoplastic bone lesions, surgical interventions are typically only one of several treatment modalities. For some of these conditions, medication options are the first, or only, line of treatment.
For a range of benign neoplastic lesions, surgical removal (resection) is the first line treatment. The extent of surgery may vary greatly and in some circumstances will necessitate surgical reconstruction to repair the defect(s) created.
For malignant neoplastic bone lesions, the overall treatment scheme and type/extent of treatment options depends to some extent on the cancer being a (rare) primary malignancy, or metastasis from some other primary malignancy (such as breast or prostate cancer). Where surgery is the first line option, it will be radical resection of the lesion wherever possible. This may lead to substantial defects in need of reconstructive surgery for repair.
Localised radiotherapy to metastatic deposits in bone (particularly the spine) can provide good palliation of symptoms but not cure.
Bisphosphonates and similar drugs have a role in the management of metastatic disease in the spine and long bones, but have not been properly assessed for application in the jaws. Also medication-related osteonecrosis of the jaws (MRONJ) needs to be kept in mind.
Next section: Bone lesion