Persistent Oral Ulcer Investigation — MFDS Part 1 MCQ

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EasyOral MedicinePersistent Oral Ulcer InvestigationMFDS Part 1

A patient has a solitary oral ulcer that has persisted for 4 weeks. No local traumatic cause or other explanation is identified. What is the most appropriate next step?

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Correct answer: D — Refer via the suspected cancer pathway

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

A is correct. NICE advises considering a suspected cancer pathway referral for unexplained ulceration in the oral cavity lasting more than 3 weeks. The priority is prompt specialist assessment to exclude oral epithelial dysplasia or malignancy; biopsy may form part of specialist investigation, but it is not the mandatory primary-care action. A further 3-month review risks diagnostic delay. A full blood count can be useful when there are features suggesting haematological or systemic disease, but it neither excludes oral cancer nor replaces referral. Antifungal treatment is inappropriate without clinical evidence of candidosis. Topical corticosteroids may be appropriate for a diagnosed inflammatory ulcerative disorder, but should not delay assessment of an unexplained persistent solitary ulcer.

Reference: National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12), recommendation 1.8.2: Oral cancer. 2015, current guidance checked August 2026. https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer