Pathology · patient case question
What is the appropriate first step for the 3 mm white lesion on the lateral tongue border in this smoker?
Patient case: White and Pigmented Oral Lesions
demo: 58-year-old male
chief: Routine examination; several mucosal findings noted.
history: Smokes one pack per day for 30 years. Occasional alcohol.
meds: None
findings: Finding 1: a small white plaque on the soft palate that does not wipe off. Finding 2: a white plaque on the lateral tongue border, 3 mm, non-wiping. Finding 3: a flat blue-grey macule in the buccal mucosa adjacent to a large amalgam restoration. Finding 4: irregular erythematous patches with white serpiginous borders on the dorsal tongue that shift location between visits. Finding 5: a bony hard midline swelling of the hard palate.
Show answer and explanation
Correct answer: C. Biopsy, because the lateral tongue is the highest-risk site for squamous cell carcinoma
- A. Empiric antifungal therapy delays diagnosis of a lesion that does not resemble candidiasis — it would wipe off if it did.
- B. Steroids may mask a dysplastic or malignant lesion and are not appropriate before diagnosis.
- C. Correct. The lateral border and ventral surface of the tongue, along with the floor of mouth, are the highest-risk intraoral sites. In a heavy smoker, a persistent non-wiping white lesion there warrants biopsy.
- D. A trial of irritant removal is reasonable when a mechanical cause is evident; here the risk profile and site argue for definitive tissue diagnosis.