page_title: Mouth ulcer
section_title: Malignancy
hierarchical_section_title: Mouth ulcer / Differential diagnosis / Malignancy
caption_attribution_description: English: Figure 1. The Dorsum of the Patient's Tongue On biopsy, the three exophytic masses turned out to be oral carcinomas, while the surrounding hyperkeratotic area showed histologic features of oral lichen planus.
context_page_description: A mouth ulcer is an ulcer that occurs on the mucous membrane of the oral cavity. Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause.
  The two most common causes of oral ulceration are local trauma and aphthous stomatitis, a condition characterized by recurrent formation of oral ulcers for largely unknown reasons. Mouth ulcers often cause pain and discomfort and may alter the person's choice of food while healing occurs.
  They may form individually or multiple ulcers may appear at once. Once formed, the ulcer may be maintained by inflammation and/or secondary infection. Rarely, a mouth ulcer that does not heal may be a sign of oral cancer.
context_section_description: Rarely, a persistent, non-healing mouth ulcer may be a cancerous lesion. Malignancies in the mouth are usually carcinomas, but lymphomas, sarcomas and others may also be possible. Either the tumor arises in the mouth, or it may grow to involve the mouth, e.g. from the maxillary sinus, salivary glands, nasal cavity or peri-oral skin. The most common type of oral cancer is squamous cell carcinoma. The main risk factors are long-term smoking and alcohol consumption (particularly when combined) and betel use.
  Common sites of oral cancer are the lower lip, the floor of the mouth, and the sides, underside of the tongue and mandibular alveolar ridge, but it is possible to have a tumor anywhere in the mouth. Appearances vary greatly, but a typical malignant ulcer would be a persistent, expanding lesion which is totally red (erythroplasia) or speckled red and white (erythroleukoplakia). Malignant lesions also typically feel indurated (hardened) and attached to adjacent structures, with "rolled" margins or a punched out appearance and bleeds easily on gentle manipulation. If someone has an unexplained mouth ulcer persisting for more than 3 weeks this may indicate a need for a referral from the GDP or GP to hospital to exclude oral cancer.
caption: Advanced oral cancer (T4 N2 M0, stage 4). Note rolled margins of central ulcer and surrounding areas of premalignant change. The patient died two months after subsequent partial glossectomy (removal of part of the tongue)
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