Lesson of the month: festinare lente - a case where a malignant ulcer was not all that it seemed to be

Abstract

As an oral surgeon, it is essential to recognise the various forms of malignancy within the mouth as promptly as possible, to diagnose accurately and early and be able to communicate effectively with a range of multidisciplinary teams. This case describes an elderly lady who was referred with a malignant-looking ulcer on the right ventral surface of the tongue. However, in spite of convincing evidence from histopathology, there remained a lingering doubt of the diagnosis with the oral surgery component of the multidisciplinary team (MDT). Comprehensive investigation and extensive discussion led to review of the diagnosis, ultimately recognising it as Epstein Barr Virus-positive mucocutaneous ulcer, a rare but reactive lymphoproliferative disorder, presenting as a relapsing and remitting ulcer. This case highlights the importance of careful preoperative assessment and clinicopathological correlation to ensure confidence in the diagnosis, particularly when dealing with unusual lesions, and should encourage active participation by all of the professional groups at the MDT meeting.