Oral leukoplakia requiring biopsy — ORE Part 1 MCQ

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ModerateOral Medicine and Oral PathologyOral leukoplakia requiring biopsyORE Part 1

A 59-year-old patient has a persistent homogeneous white patch on the floor of mouth. It cannot be wiped away, no local frictional cause is identified, and it has remained unchanged after smoking cessation advice and review. There is no pain. What is the most appropriate investigation?

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Correct answer: A — Specialist assessment with biopsy of the lesion

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

Answer B: Persistent oral white patches require specialist referral for biopsy and histopathological examination (gold standard per UK national guidance and NHS/NICE standards). Homogeneous appearance does not exclude dysplasia or malignancy; tissue diagnosis is mandatory. Nystatin (A) is inappropriate—candidiasis is already excluded by the clinical presentation (non-removable patch, no friction history). Bitewing radiographs (C) do not assess soft tissue and are not indicated. Patch testing (D) has no role in oral mucosal lesions. FBC alone (E) provides no diagnostic information for oral pathology and misses the need for histological assessment. This item discriminates between candidates who understand the mandatory pathway for suspected oral leukoplakia and those who might confuse it with other common oral conditions.

Reference: GOV.UK Delivering Better Oral Health – Chapter 6: Oral Cancer (2025) & NHS Leukoplakia guidance; NICE Suspected Cancer referral guidelines referenced therein, https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-6-oral-cancer