Photo Rounds

Lesion on side of tongue

A 56-year-old homeless woman went to see her family physician (FP) about a nonhealing painful lesion on the side of her tongue. The lesion had increased in size recently and she was worried because her dad had died from oral cancer. The patient had smoked since she was 11 years old and acknowledged being a heavy drinker.

What's your diagnosis?


A punch biopsy revealed that the patient had a squamous cell carcinoma (SCC).

Fully two-thirds of oropharyngeal cancers (OPCs) will present with advanced disease at the time of diagnosis. Ninety percent of OPCs are of the squamous cell type. Reports in the literature suggest that clinicians may be missing early disease by not conducting thorough soft-tissue examinations on a routine basis. However, the fact that more than 35% of patients do not see a dentist on a routine basis likely contributes to the diagnostic delay. The 5-year survival rate for OPC is 62% for whites and 42% for blacks.

Tobacco use is the major risk factor for OPC and is implicated in approximately 75% of cases. Alcohol use is also a major risk factor. The combined use of tobacco and alcohol increases the risk of OPC far more than either alone. Human papillomavirus (especially HPV 16) is a newly recognized major risk factor for carcinomas affecting the lingual and palatine tonsils.

The principal therapeutic modalities for OPC are surgery, radiotherapy, and chemotherapy. This patient was referred to a head and neck surgeon.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Huber M, Gonsalves W. Oropharyngeal cancer. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:253-256.

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