Suspected oral squamous cell carcinoma — ORE Part 1 MCQ

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EasyOral Medicine and Oral PathologySuspected oral squamous cell carcinomaORE Part 1

A 62-year-old smoker presents with a firm ulcer on the lateral border of the tongue that has persisted for four weeks. It is indurated with rolled margins and there is a palpable ipsilateral neck node. Denture trauma has been excluded. What is the most appropriate investigation?

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Correct answer: D — Urgent suspected cancer referral for biopsy and specialist assessment

This patient has a clinically high-risk presentation for oral squamous cell carcinoma: age (62), significant smoking history, a persistent (4-week) indurated ulcer with rolled margins on the lateral tongue (a common site), and an ipsilateral cervical lymph node. Per NICE NG12 guidance on suspected cancer referral, this combination warrants urgent (two-week wait) referral to specialist assessment. Biopsy is the gold standard for definitive diagnosis and can only be performed by a specialist. Option A (delayed review with chlorhexidine) risks disease progression and is inappropriate for suspected malignancy. Option B (antifungal without referral) mischaracterises the lesion—candidiasis does not typically present with induration and rolled margins. Option E (bitewing radiography) does not help diagnose an oral surface lesion and delays necessary referral. Option C (occlusal adjustment) incorrectly assumes a benign cause despite clear malignant features and clinically excluded trauma. The correct answer is D.

Reference: NICE NG12 (2015): Suspected cancer: recognition and referral. https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer; supported by NHS England regional implementations (Devon formularies, updated November 2024)