Squamous Cell Carcinoma — ORE Part 1 MCQ

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EasyOral MedicineSquamous Cell CarcinomaORE Part 1

A 70-year-old man who smokes 20 cigarettes daily presents with an ulcer on the right lateral border of his tongue that has persisted for 5 weeks. It has raised rolled edges and is indurated on palpation. A firm level II cervical lymph node is palpable. What is the most appropriate action?

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Correct answer: A — Make a suspected-cancer pathway referral

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · E = shown as D · B = shown as E

C is correct. This is an unexplained tongue ulcer persisting for more than 3 weeks, with induration, rolled edges and a palpable cervical node, making oral squamous cell carcinoma highly suspicious. NICE NG12 advises consideration of a suspected-cancer pathway referral for unexplained oral ulceration lasting over 3 weeks. Referral enables specialist assessment, imaging and appropriately planned diagnostic biopsy. Chlorhexidine or antibiotics with review would inappropriately delay assessment. An intraoral periapical radiograph does not investigate a soft-tissue oral malignancy or cervical nodal disease. A diagnostic biopsy may ultimately be required, but in this setting the appropriate primary-care action is urgent referral rather than independently arranging biopsy in general dental practice.

Reference: National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12), oral cancer recommendations, last updated 15 April 2026. https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer