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Recommend excisional biopsy when the spot is on the palate or upper gum, has been present for an unknown duration, has any irregular features (asymmetry, ragged borders, mixed colour, recent change), or is in an aesthetically important area where the patient would like it removed

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Erstad 2022) Causes of disproportionately elevated free phenytoin levels (when compared with the total phenytoin level) are listed below

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