Photo Quiz

A Fungating Lesion on the Tongue


Am Fam Physician. 2016 Apr 1;93(7):599-600.

A 31-year-old man presented with a lesion on his tongue that he first noticed six months earlier as small red dots. His dentist thought it was caused by irritation from his dental bridge. It was painless, but he had some bleeding after brushing his teeth and tongue. He had not received any medical care for the lesion.

His medical history was significant for hypertension treated with hydrochlorothiazide, and a recent clavicle fracture after a motorcycle accident. He never smoked, but he used one can per week of chewing tobacco for one year. He quit five years before presentation. He drank less than three alcoholic beverages per week. A review of systems was negative. He was not using any new toothpastes or mouthwashes.

On physical examination, he was well appearing and afebrile, but overweight. His tongue had a large lateral fungating, whitish, exophytic lesion with anterior fissuring of the entire left side of the tongue (Figure 1). There was no tenderness or ulceration. He had a slight speech impediment secondary to mouth fullness but no difficulty swallowing. There were no palpable cervical lymph nodes.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Mucosal candidiasis.

B. Oral leukoplakia.

C. Oral pyogenic granuloma.

D. Squamous cell carcinoma.

Address correspondence to Alyson J. Brinker, MD, at Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.


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This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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