Oral Ulcer Investigation — ORE Part 1 MCQ

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ModerateOral MedicineOral Ulcer InvestigationORE Part 1

A 60-year-old man presents with a unilateral painless ulcer on the right lateral border of the tongue. It has been present for 8 weeks and has an indurated, raised border. He does not smoke or drink alcohol. What is the most important investigation?

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Correct answer: C — Incisional biopsy of the ulcer margin

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

This presentation is highly suspicious for oral squamous cell carcinoma: persistent painless ulcer with indurated raised border on lateral tongue (high-risk site) in a 60-year-old. NHS guidance specifies incisional biopsy as the standard diagnostic approach for suspected oral cancer on accessible mucosal sites. An incisional biopsy removes a representative wedge of tissue including normal margin and affected tissue, permitting histopathological assessment of invasion, differentiation, and margin status—essential for staging and treatment planning. Excisional biopsy (B) removes the entire lesion without margin assessment and compromises surgical staging. Fine needle aspiration (C) lacks tissue architecture and is insensitive for cancer. Autoimmune markers (D) are not indicated without systemic features or recurrent/multifocal presentation. Toluidine blue staining alone (E) is an adjunctive screening tool, not diagnostic and cannot replace biopsy.

Reference: NHS (2024). 'Mouth cancer - Diagnosis.' Available at: https://www.nhs.uk/conditions/mouth-cancer/diagnosis/ and SDCEP (2024). 'Oral Ulceration – MADP.' Available at: https://madp.sdcep.org.uk/content/conditions-library/oral_ulceration.html