Persistent Ulcer Referral — ORE Part 1 MCQ

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EasyOral MedicinePersistent Ulcer ReferralORE Part 1

A patient has an unexplained ulcer in the oral cavity that has persisted for 4 weeks. No traumatic, infective or other local cause is identified. According to NICE NG12, what is the most appropriate next step?

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Correct answer: D — Make a suspected cancer pathway referral

The correct answer is D. NICE NG12 recommendation 1.8.2 advises considering a suspected cancer pathway referral for unexplained ulceration in the oral cavity persisting for more than 3 weeks. This ulcer has lasted 4 weeks and no local cause has been found, so it meets the referral criterion. A routine 3-month review would inappropriately delay assessment. Topical corticosteroids or silver nitrate may alter or damage the lesion without establishing its cause and could delay diagnosis. An incisional biopsy may ultimately be required, but the appropriate initial action in this setting is urgent specialist assessment through the suspected cancer pathway rather than delaying referral for an in-practice biopsy.

Reference: National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12), recommendation 1.8.2, updated 15 April 2026. https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer