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How would you diagnose this case?
A 38-year-old male was referred to the oral pathology service by his dentist for evaluation of a lesion at the left tongue. The patient reported intermittent episodes of discomfort over the preceding 3 to 4 months. He attributed the symptoms to local trauma, noting a history of parafunctional habits including tongue biting, clenching and grinding, which he associated with work-related stress. He was unable to tolerate use of a protective mouthguard. The medical history was noncontributory. The patient had no history of tobacco use and reported only rare alcohol intake. Extraoral examination revealed no cervical lymphadenopathy. Intraoral examination demonstrated a small (6-7mm) ragged ulcer at the left posterior lateral tongue without obvious induration (Fig. 1). The adjacent dentition was smooth and nonirritating. An incisional biopsy was recommended but initially declined by the patient, who attributed signs and symptoms to local trauma. Following further discussion and persistence of the lesion, the patient ultimately consented to the procedure (Fig. 2).
Fig. 1
Fig. 2
What would be the most appropriate next steps in management?
A. Assuming the lesion is traumatic in origin, provide reassurance, and monitor for healing.
B. Recommend fabrication of a new occlusal splint to reduce potential trauma.
C. Refer the patient to a tertiary care center for oncologic evaluation and staging.
D. Prescribed a topical corticosteroid.
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