Tongue Ulcer Urgent Referral — ORE Part 1 MCQ

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EasyOral MedicineTongue Ulcer Urgent ReferralORE Part 1

A 45-year-old woman presents with an indurated ulcer on the ventral surface of her tongue. It has been present for 6 weeks and there is no identified traumatic cause. She does not smoke or drink alcohol. What is the single most important next step?

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Correct answer: D — Make a suspected cancer pathway referral

The correct answer is D. An unexplained oral ulcer persisting for more than 3 weeks meets NICE NG12 criteria for a suspected cancer pathway referral. This lesion has persisted for 6 weeks, is indurated and is on the tongue, so malignancy must be excluded irrespective of the absence of tobacco or alcohol exposure. SDCEP similarly advises urgent assessment, with possible Urgent Suspicion of Cancer referral, for ulceration present for 3 weeks or more. Chlorhexidine may be appropriate for short-lived recurrent self-limiting ulceration, not a persistent red-flag lesion. Topical corticosteroids are used only after an appropriate benign inflammatory diagnosis is established. Antibiotics are unsupported without evidence of bacterial infection. Reassurance or delayed review risks delaying diagnosis of oral squamous cell carcinoma.

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