A patient has a raised lesion on the buccal mucosa measuring several millimetres, with a 2 mm ulceration on its surface. What is the correct descriptive term, and what is the appropriate management?

Correct answer: C. Nodule — excisional biopsy

• A. A macule is FLAT — a circumscribed change in colour with no elevation — which contradicts the description of a raised lesion.
• B. A vesicle is a fluid-filled elevation under 5 mm, and cytology is not the diagnostic approach for a solid ulcerated mass.
• C. CORRECT on both counts. A NODULE is a solid, raised lesion greater than 5 mm in diameter. Because this lesion is small and well circumscribed, EXCISIONAL biopsy is appropriate — it removes the lesion entirely and provides the diagnosis in a single procedure.
• D. A papule is a solid raised lesion LESS than 5 mm, and observation alone is not appropriate for a lesion that has ulcerated.

Note: Choosing the biopsy type: EXCISIONAL for lesions under about 1 cm that are well circumscribed and appear benign — remove it all with a margin. INCISIONAL for lesions over 1 cm, diffuse lesions, lesions with a suspicious appearance, or lesions in an anatomically difficult location — sample the most representative area including the lesion-normal interface, and avoid necrotic centres.