Image Based Discussion

General
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Image-Based Clinical Case

Patient Presentation

A 52-year-old male presents to the oral medicine clinic with a non-healing ulcer on the lateral border of the tongue that has been present for approximately 3 months.

Image based case discussion
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Medical and Social History

  • 25-year history of tobacco smoking (5-6 Beedi per day)
  • Occasional alcohol consumption
  • No history of recent trauma reported
  • No significant systemic illness

Clinical Examination

Intraoral examination reveals:

  • A solitary ulcer measuring approximately 2 cm × 1.5 cm
  • Located on the right lateral border of the tongue
  • Irregular shape
  • Everted (rolled) margins
  • Indurated base on palpation
  • Mild tenderness
  • No obvious source of local irritation

QUESTIONS

  1. What is your provisional diagnosis based on the clinical presentation?
  2. What differential diagnoses would you consider?
  3. What does the term induration indicate clinically?
  4. Which cervical lymph nodes would you examine carefully in this patient?
  5. What investigations would you order after confirming the diagnosis?

MBH/PS

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Carcinoma of tongue.

It can be premalignant lesions like leukoplakia.

Level 1-3 cervical nodes.

Investigation - Edge biopsy to confirm the diagnosis. And CT PNS, neck and thorax to look for extent of metastasis.

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