The image shows the tongue of a 62-year-old greengrocer who had noticed a small area of white discoloration at the center of his tongue 3 or 4 years ago. This had gradually enlarged to its present size, but was quite painless.
He was a heavy cigarette smoker – 30 a day – a habit that commenced in his teens. He had lost all his teeth by the time he was 40 and, since then, had well-fitting complete upper and lower dentures. He was a ‘social drinker’, beer only.
On clinical examination, he was a rather overweight but healthy man. The white plaque was slightly thickened, not ulcerated and quite painless to touch. The mouth was otherwise normal and the cervical lymph nodes were impalpable. He was mildly hypertensive (165/95) but apart from this, the full clinical examination was normal.
What’s the diagnosis ?
