A 60 Y male smoker patient comes with growth in the left side tongue for 22 days.
What is the probable Diagnosis?
“Suggest a doctor in the Mymensingh area.”
There is a lesion on the lateral side of the tongue, which appears ulcerative and possibly leukoplakic. Given the patient’s history—60-year-old male, chronic smoker, and a 22-day history of a tongue lesion—the most probable diagnosis is oral squamous cell carcinoma (OSCC). Other possibilities include leukoplakia with dysplasia or traumatic ulceration, but given the risk factors, malignancy should be ruled out urgently.
Next Steps:
Biopsy: Incisional biopsy for histopathology.
Imaging: MRI or CT scan to check for local spread.
1. Ulcerative Lesions (e.g., Aphthous Ulcers, Traumatic Ulcers, etc.)
🔹 Symptoms:
- Painful open sores in the mouth or on the tongue/cheeks
- Red halo around the ulcer
- White or yellowish base
- Difficulty eating, drinking, or speaking
🔹 Causes:
- Trauma: Biting the cheek/tongue, sharp teeth, ill-fitting dentures
- Nutritional deficiencies: Iron, folate, Vitamin B12
- Infections: Herpes simplex virus, fungal or bacterial infections
- Autoimmune conditions: Behçet’s disease, Crohn’s disease
- Stress or hormonal changes
- Drug-induced: NSAIDs, chemotherapy
🔹 Medication Management:
- Topical corticosteroids:
e.g., triamcinolone acetonide (Kenalog in Orabase) - Antiseptic mouthwashes:
e.g., chlorhexidine gluconate 0.12% - Topical anesthetics:
e.g., benzocaine gel - Vitamin supplements if deficient
- Systemic steroids or immunosuppressants (for severe/autoimmune cases)
Symptoms: ⚪ 2. Leukoplakia (White Patch in the Oral Mucosa)
- Thick, white patches on the tongue, inside of cheeks, or gums
- Usually painless, but may become sensitive
- Cannot be scraped off (unlike candidiasis)
- May have rough or hardened texture
🔹 Causes:
- Tobacco use (smoking/chewing)
- Alcohol consumption
- Chronic irritation: rough teeth, dentures, cheek biting
- Human papillomavirus (HPV)
- Precancerous potential: A subset may develop into oral cancer
🔹 Medication and Management:
- Eliminate risk factors:
Stop tobacco and alcohol use - Surgical removal/biopsy:
If persistent or shows dysplasia - Topical retinoids or antifungals:
e.g., tretinoin, if hyperkeratosis is prominent - Regular monitoring:
6-monthly oral examinations and biopsies if needed
- When see to a Doctor
- Ulcers lasting more than 2–3 weeks
- White patches that do not go away
- Rapid changes in lesion appearance
- Pain interfering with eating or speaking
Raiyyan Tahsan. Date:-10-05-2025 Saturday Time:-08-16-39 Am