An aggressive, solitary non-healing ulcer: Not always cancerous

Any “single persistent oral ulcer showing no sign of healing ten to fourteen days after any putative trauma is removed, then it must be considered as malignant, unless proven otherwise” [1]. A 63 year old farmer, a known smoker and beetle nut chewer for over thirty five years, presented to our hospital with three month old complaints: (i) pain in the left side of the mouth, which was aggravated whenever he opened his mouth to talk and chew food. Painwas secondary to an ulcerative lesion present in the left buccal mucosa, which gradually increased in size to involve the left angle of the mouth; (ii) progressive trismus for over a month; (iii) productive cough with scanty, white, mucoid, non-foul smelling, nonblood stained sputum; (iv) fever was intermittent, low-grade not associated with chills, rigors, or night sweats. He had no significant past, family or allergy history. He denied losing weight and having reduced appetite. The differentials considered were: (I) malignancy (II) infection. On examination, he was found to be moderately built, poorly nourished, pale, with digital clubbing, and a fever of 101 F associated with night sweats. His respiratory system examination revealed bilateral scattered crepitations on auscultation. He was immunocompetent. Local examination revealed: a solitary, non-healing ulcer in the left oral cavity, irregularly shaped, measuring 2$5 cm 3 cm. From its location in the left buccal mucosa, it extended anteriorly to involve the left commissure, left mucocutaneous junction of both lower and upper lip. Its posterior extent was 3 cm from the commissure. Medially extending to the left labial mucosa and