What is the first diagnostic step for a mandibular mass in an elderly patient?

• A. Excisional biopsy
• B. CT scan
• C. Fine-needle aspiration biopsy
• D. Observation

Answer: (C)

The first step is to obtain a tissue diagnosis with a fine-needle aspiration biopsy. This minimally invasive procedure provides cytologic material from the lesion, allowing you to distinguish malignant from benign processes and to identify the likely tumor type. Knowing the histology early helps guide the rest of the workup and management, including whether further imaging or a surgical plan is needed. Imaging like a CT scan is important for assessing the extent of bone involvement and planning treatment, but it cannot replace tissue diagnosis. An excisional biopsy is more invasive and may not be appropriate as the initial step, especially in an elderly patient where you want to minimize morbidity. Observation is not reasonable given the need to rule out malignancy.