Leukoplakia — ORE Part 1 MCQ

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ModerateOral MedicineLeukoplakiaORE Part 1

A 55-year-old man presents with a painless white patch on the lateral border of his tongue that cannot be scraped off. He has a 30-pack-year smoking history. What is the most appropriate initial management?

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Correct answer: B — Urgent referral for biopsy via 2-week wait pathway

The correct answer is B. This presentation is consistent with oral leukoplakia at high risk of malignancy: the lesion is non-scrapable (ruling out candidiasis), located on the lateral tongue (a high-risk site), and the patient has substantial smoking exposure. Oral leukoplakia carries an annual malignant transformation risk of 2–3%, making conservative observation inappropriate. Histopathological biopsy is the gold standard for diagnosis and risk stratification. UK NICE guidance, referenced in Gov.UK's oral cancer chapter, establishes the 2-week wait urgent referral pathway as standard for suspected oral cancer. Distractors: A and E delay specialist assessment and biopsy; B misidentifies the lesion as candidiasis (incompatible with non-scrapability); D initiates treatment without diagnostic confirmation, which is unsafe in premalignant disease.

Reference: Gov.UK Chapter 6: Oral Cancer (September 2025), referencing NICE Suspected cancer: recognition and referral guidance; Epstein et al., 2018, 'A clinical diagnosis of oral leukoplakia: A guide for dentists' (PubMed Central PMC5822541), https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-6-oral-cancer