[Squamous cell carcinoma of the tongue].

A 38-year-old-female presented at the Oral Medicine Clinic complaining of pain under her tongue that became worse during chewing, and radiated to her right ear. The pain started two months earlier and gradually increased in intensity. The patient reported that she smoked about twelve cigarettes per day, a habit that she maintained for the last twenty years. She also admitted that she consumed alcohol as a social habit, mainly over the weekends. Her medical history revealed no other abnormalities and she was not using any chronic medication. The patient was febrile at the time of examination. Extra-oral examination revealed a raised skin lesion on the bridge of the nose and several similar, but smaller, lesions on her cheeks. The skin lesions were darker in colour than the surrounding normal skin and were suggestive of chronic sun damage. A right jugulo-digastric lymph node was found to be swollen and tender, but it was neither fixed nor hard in consistency. intra-orally, a large crater-like ulcer with rolled and indurated margins was seen on the right lateral border of the tongue (Figure 1). A diffuse leukoplakic patch was present on the right antero-ventral surface of the tongue (Figure 2) and a similar lesion was seen on the contralateral surface of the tongue. in addition, a more pronounced and well-circumscribed leukoplakic plaque was discovered on the floor of the mouth, lingual to tooth 33 (Figure 3). An incisional biopsy of the ulcer and an excisional biopsy of the leukoplakic patch on the floor of the mouth were performed under local anaesthesia. Both biopsies were sent for histopathological investigation and the patient was instructed to use 0.2% aqueous solution of chlorhexidine digluco-nate as an antibacterial mouthwash, twice daily. The patient was advised to refrain from smoking and requested to return a week later for suture removal and further consultation. The clinical appearance of the ulcer was suggestive of a squamous cell carcinoma, a traumatic eosinophilic ulcer or a syphilitic/tuberculous ulcer. Histopathological evaluation of the specimen taken from the margin of the ulcer showed saDJ February 2013, vol 68 no 1 p32-p34 s stander