The patient, a 73-year-old alert, normally developed, white woman, in no distress, was referred for evaluation of an unusual-appearing extraction site. The mandibular left second molar had been extracted without complication because of periodontal and pulpal disease 2 months previously. No postoperative antibiotics or surgical packings were used, and subsequent healing was unremarkable, with no evidence of excessive inflammation. One month later, the patient was seen for a prosthodontic consultation, at which time the extraction site was noted to be surfaced by rough, relatively pale, asymptomatic soft tissue. At 2 months, the soft-tissue changes were noted to be persistent and the patient was referred to our clinic for evaluation. At the time of our initial evaluation the patient was taking Cardizem (Marion Laboratories, Kansas City, MO), Zantac (Glaxo Pharmaceuticals, Glaxo, NC), and ASA. She reported an allergy to penicillin characterized as urticaria. She denied past or present tobacco or ethanol use. She was currently under the care of a physician for occasional angina and a hiatal hernia. She had a partial left arm paralysis as the result of a vertebral injury 29 years ago.. She had undergone a bilateral mastectomy and left unilateral axillary node dissection 28 years ago for carcinoma of the breast. She denied all other central nervous system, respiratory, cardiovascular, gastrointestinal, genitourinary, skin, musculoskeletal, hematologic, or allergic disease or abnormality past or present. The patient had a past history of routine regular dental care. She wore no removable prosthetic appliances. Extraoral examination showed no tenderness of the masticatory muscles, temporomandibular joint, or carotid or temporal artery to palpation. There was no restriction of, or pain during, mandibular movements. No temporomandibular joint noise was auscultated during jaw movements. Tbe patient was afebrile and there was no submandibular or anterior cervical lymphadenopathy. Gross analysis of cranial nerves III-XII was within normal limits, including pinprick sensory evaluation of the left third division of the trigeminal nerve. The intraoral examination showed rough, fissured,