History of the present illness

This is a 32-year old white female who presented at the Auburn Oral & Maxillofacial Surgery Clinic with a 3-month history of a painful, slowly enlarging "ulcer" on the left vental/lateral border of the tongue (Figure 1) for which she was taking Vicodin. The lesion was described as 2 x 4 cm in size, reddish-white, and ulcerated. The patient reported pain on swallowing and was beginning to have difficulty swallowing solid foods, which prompted her presentation. There were no palpable cervical lymph nodes noted by either of the two surgeons. The CT scan however, revealed one irregular-appearing level IIA lymph node, 1.7cm in diameter.

Figure 1 This photograph represents the lesion at first clinical presentation and before surgery. Note the diffuse deep ulcers on the left lateral and ventral tongue with focally rolled bordered.