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Oral SCC Diagnosis — MFDS Part 1 MCQ

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ModerateOral MedicineOral SCC DiagnosisMFDS Part 1

A 64-year-old patient has a solitary painless ulcer on the lateral border of the tongue that has persisted for 6 weeks. It is indurated and has an everted margin. Incisional biopsy shows irregular islands of atypical squamous epithelial cells invading the underlying connective tissue, with keratin pearl formation. What is the most likely diagnosis?

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Correct answer: C — Squamous cell carcinoma

The diagnosis is squamous cell carcinoma. The persistent painless, indurated tongue ulcer with an everted margin is clinically suspicious, while invasion of connective tissue by atypical squamous epithelial islands with keratin pearls is diagnostic of a keratinising squamous malignancy. A traumatic ulcer should have an identifiable local cause and lacks malignant epithelial invasion. Major aphthous ulcers are usually painful and occur in a recurrent pattern. An eosinophilic ulcer can clinically mimic carcinoma, particularly on the tongue, but biopsy shows a deep eosinophil-rich inflammatory infiltrate rather than invasive keratinising epithelial islands. A primary syphilitic chancre may be solitary and painless but does not produce this malignant histological pattern.

Reference: Chandra S et al. Oral erythroplakia harbouring a squamous cell carcinoma. BMJ Case Reports. 2022;15:e247983. https://casereports.bmj.com/content/15/2/e247983