Rapid Communication| Volume 133, ISSUE 4, P363-368, April 2022

An ulcerated nodule on the tip of the tongue of a patient with skin lesions

Published:August 08, 2021DOI:
      A 66-year-old male patient was referred with a chief complaint of an asymptomatic ulcerated nodule on the tongue with 2 months of evolution. The patient’s medical history included hypertension; multiple basal cell carcinomas on the skin, which were surgically treated; and prostate cancer, which was still being treated with radiotherapy. The patient also reported the use of antiandrogens. Information on tobacco or alcohol consumption was not elicited. Extraoral examination revealed facial lesions characterized by areas of hypo- and hyperpigmentation of the skin, actinic lentigines, actinic keratosis, and actinic cheilitis (Figure 1A-1D). Ocular alterations, including hyperemia, loss of eyelashes, and pterygium, were also observed. Intraoral examination revealed a single oval-shaped nodule, with a distally discrete ulcerated area presenting slightly elevated white edges with granular surface and an erythematous center, located in the left apex of the tongue. The entire lesion presented a fibrous consistency and well-defined margins and measured approximately 1.0 × 0.5 cm (Figure 2). Clinical assessment of cervical lymph nodes did not show evidence of regional metastasis.
      Fig. 1
      Fig. 1Extraoral findings of the case. (A-C) Multiple skin lesions on both facial sides, extending to the neck and scalp, which included hyper- and hypopigmented macules, actinic lentigines, and actinic keratosis. (D) Blurred interface between the vermillion mucosa and the cutaneous part of the lips.
      Fig. 2
      Fig. 2Clinical features of the intraoral lesion. (A) Anteriorly, an oval-shaped nodule presenting an area with elevated white edges and erythematous center. (B) In a high-power view, 2 distinct areas of the lesion are observed, as well as its well-defined margins.
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