Pathology · single question
A smoker has a whitish lesion on the tongue that has NOT resolved. What is the FIRST step?
Show answer and explanation
Correct answer: D. Advise the patient to quit smoking and re-evaluate
- A. Incorrect. Oncology referral is premature before attempting conservative management and biopsy.
- B. Incorrect. Biopsy is indicated if the lesion persists after eliminating the irritant (tobacco) — not as the immediate first step before trying to remove the cause.
- C. Incorrect. Antifungal therapy is appropriate if the lesion is wiped off (candidiasis). A persistent white lesion that is NOT wiped off requires different management.
- D. Correct. For a SMOKER with a persistent white lesion on the tongue, the FIRST step is to ADVISE THE PATIENT TO QUIT SMOKING and schedule a re-evaluation in 2–3 weeks. Some tobacco-related white lesions (smoker's keratosis) will RESOLVE with smoking cessation — allowing differentiation from true leukoplakia. If the lesion PERSISTS after cessation, BIOPSY is the next step.