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Mental neuropathy (numb chin syndrome). A harbinger of tumor progression or relapse
R K Burt1, W H Sharfman, B I Karp
1Clinical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892.
Abstract:
The authors report four patients whose initial symptom of tumor recurrence or progression was unilateral numbness of the chin. Two patients had Hodgkin lymphoma, one had malignant melanoma, and one had prostate cancer. Physical examination was notable only for unilateral anesthesia of the chin and lower lip. Diagnostic evaluation, including computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain, plain radiographs of the mandible, and cerebrospinal fluid analysis for protein, glucose, and cytology were normal. Bone scans revealed osseous lesions in the axial skeleton of all patients, whereas only two patients had abnormal uptake in the mandible. The authors conclude that in the setting of a negative evaluation for central nervous system (CNS) or local mandibular disease, mental neuropathy is associated with recurrent or progressive skeletal disease. In addition, to document relapsed or progressive cancer, the skeletal system may have to be examined at sites distant from the mandible.
Insights
Unilateral chin numbness can signal cancer recurrence. This mental neuropathy may indicate skeletal disease progression, even with normal brain scans.
Area of Science:
- Oncology
- Neurology
- Radiology
Background:
- Cancer recurrence can present with subtle, atypical symptoms.
- Early detection of metastatic disease is crucial for patient outcomes.
Observation:
- Four patients presented with unilateral chin numbness as the sole initial symptom of cancer recurrence.
- Physical examination revealed only anesthesia of the chin and lower lip.
- Standard diagnostic imaging (CT, MRI) and cerebrospinal fluid analysis were unremarkable.
Findings:
- Bone scans identified axial skeletal lesions in all patients.
- Two patients also showed abnormal uptake in the mandible.
- Mental neuropathy correlated with widespread skeletal metastatic disease.
Implications:
- Unilateral mental neuropathy may be an early indicator of occult skeletal metastases.
- Comprehensive skeletal imaging is recommended when this symptom arises in cancer patients.
- This finding highlights the importance of considering distant skeletal involvement in cancer progression.