History of the present illness

This is an 82-year-old white female whose chief complaint was a painful lesion in the right posterior palate associated with the palatal gingiva of tooth # 2 (Figure 1).  The patient stated that the lesion was painful and that "it feels like it festers."  The lesion had a distinct rolled border with a crater that was focally ulcerated.  The lesion was not uniform in color.  It had a spectrum of discoloration ranging from tan spots away from the rolled border to brown and deep brown, almost black, around the rolled border.  It was of six weeks' duration.   

Figure 1 Clinical photograph of the lesion taken at the first visit.  Note the rolled border with central concavity and focal ulceration.  Also note the range of discoloration from tan to deep brown