History of the present illness

This is a 64-year old white male who was referred with a two-year history of right lower lip lesion which was slowly enlarging. At presentation, this lesion was red and ulcerated (Figure 1) and was firm but not painful. It was 1.5 X 1.5 cm in greatest dimensions. The patient gives a 30 plus year history of smoking and indicates that “the ulcer is right where I hold my cigarette”. There was no evidence of lymphadenopathy. An incisional biopsy was performed and submitted for histologic evaluation.

Figure 1 This clinical photograph represents the lesion at the first clinical presentation and before surgery. It is a non-healing, deep and rolled-bordered ulcer on the right side of the lower lip.