Persistent Tongue Lesions: When to Seek Further Medical Evaluation?

Red and white protrusions on the tongue margins?

About five years ago, I had a persistent ulcer on the edge of my tongue that did not heal.
I went to the hospital for a biopsy, and the results indicated "a mass on the tongue with epidermal hyperplasia and moderate dysplasia." Since then, I have been monitored, and there haven't been any significant issues, although that area has become more prone to ulceration.
About 7 to 8 months ago, a red raised lesion suddenly appeared in the same location (reddish and whitish), but it has not continued to grow.
Approximately five months ago, I had a simple biopsy done at a clinic (removing most of the raised lesion), and after examination, there were no significant concerns.
However, the lesion has returned to its original size and has maintained that size for one to two months, and it does not usually hurt (only hurts when I eat spicy food).
The lesion feels slightly harder than the tongue.
Should I consider getting further examination?

Wendy, 20~29 year old female. Ask Date: 2020/11/23

Dr. Zheng Jueyi reply Otolaryngology

Hello, if there are still persistent lumps and the previous biopsy showed moderately differentiated carcinoma, it is recommended to continue regular follow-up visits for medical examinations.
Whether another biopsy is necessary will be determined by the clinical physician.
Wishing you safety and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2020/11/23

More Info

Persistent tongue lesions, especially those that have been present for an extended period, warrant careful evaluation. Given your history of a tongue lesion that has shown signs of dysplasia (moderate differentiation), it is crucial to remain vigilant. The fact that you have had a biopsy in the past which indicated "epidermal hyperplasia with moderate dysplasia" suggests that there is a potential risk for malignant transformation.
In your case, the recent development of a red, raised lesion that has not significantly changed in size over the past few months is noteworthy. While the lesion does not cause pain except when consuming spicy foods, the hardness of the lesion compared to the surrounding tissue is a point of concern. Lesions that are firm or hard can sometimes indicate a more serious underlying condition, including the possibility of squamous cell carcinoma, especially in the context of your previous biopsy results.

Here are some considerations for when to seek further medical evaluation:
1. Duration and Change: If the lesion has been persistent for five years and has changed in appearance or size, it is advisable to seek further evaluation. Even if it has not significantly increased in size recently, the fact that it has returned to a previous state after being excised suggests that it may not be resolving on its own.

2. Symptoms: While you mentioned that the lesion does not cause pain except with spicy foods, any discomfort, changes in sensation, or difficulty in eating or swallowing should prompt a visit to a healthcare provider.

3. Biopsy History: Given your previous biopsy results indicating moderate dysplasia, it is essential to have regular follow-ups. Dysplastic lesions can progress to cancer, and ongoing monitoring is crucial.

4. Physical Examination: A thorough examination by an oral surgeon or an otolaryngologist (ENT specialist) is warranted. They can assess the lesion's characteristics and may recommend imaging studies or a more extensive biopsy if necessary.

5. Risk Factors: Consider your risk factors, such as tobacco use, alcohol consumption, or any history of HPV infection, which can increase the risk of oral cancers. If you have any of these risk factors, it is even more critical to seek evaluation.

6. Professional Guidance: If you have any doubts or concerns about the lesion, it is always better to err on the side of caution. Consulting with a healthcare provider who specializes in oral lesions can provide peace of mind and ensure that any potential issues are addressed promptly.

In conclusion, given your history and the current state of the lesion, it would be prudent to seek further medical evaluation. A healthcare provider can perform a detailed examination and may recommend additional diagnostic tests, including imaging or a more comprehensive biopsy, to rule out any serious conditions. Early detection and intervention are key in managing any potential malignancies effectively.

Similar Q&A

Understanding Tongue Issues: Seeking Help for Persistent Symptoms

Hello Dr. Zheng, I have white coating on my tongue, almost the entire surface is turning white. The edges of my tongue appear wavy, and I constantly feel a burning sensation on the surface. This condition has persisted for about six months. During this time, I visited a dentist w...

Dr. Zheng Jueyi reply Otolaryngology
Hello: The common issue is still inflammation of the tongue, with the main related specialties being Otolaryngology, Dentistry, Infectious Diseases, or Rheumatology. If examinations show no significant abnormalities, it is advisable to address potential chronic irritants, such as...

Understanding Small Blood Blisters on the Tongue: When to Seek Medical Help

Hello doctor, I accidentally bit my tongue, and when I got home and took a shower, I noticed a small area on my tongue that looks like dark blood. Should I seek medical attention for this, or is there something I can do to make it go away? I'm concerned that it might get inj...

Dr. Xiao Yongxun reply Family Medicine
Dear Ms. Yan: When considering oral diseases involving the tongue, the following issues should be taken into account: 1. Common infections of the lips are primarily caused by Candida, leading to thrush, and herpes simplex virus, resulting in oral herpes. 2. Aphthous ulcers, a...

Understanding Tongue Issues: When to Seek Further Medical Attention

Hello Doctor, my tongue has been numb for several days, and I have pain on both sides. I went to the hospital for an examination the day before yesterday, and they said it was tongue inflammation. However, the next day after the examination, I noticed many small red spots on my t...

Dr. Zheng Jueyi reply Otolaryngology
Hello: It is common to experience inflammation of the tongue. If it persists for more than 1-2 weeks without improvement, a follow-up appointment for further examination is necessary. Wishing you peace and health! Sincerely, Dr. Dian Jue-Yi, Director of the Department of Otolaryn...

Persistent White Circular Lesion on Tongue: Causes and Treatments

In February of this year, I developed a lesion on the tip of my tongue, which I believe is due to excessive heat in my body, as I often get mouth sores. It appears as a small, rough, circular patch. I bought an oral ointment to apply, and it improved, but it didn't last long...

Dr. Li Jiaxuan reply Otolaryngology
Without seeing the patient, it is difficult to diagnose the specific condition; however, based on your description, it is most likely a cystic formation following a tear in the epidermis and dermis. In such cases, the newly formed skin typically does not adhere to the surrounding...