Sir, a 22-year-old mother presented to us, complaining of a sore area on the left side of her tongue, present for about two weeks. There was no other relevant medical history nor adverse oral habits. She had initially reported to a physician who suspected a local traumatic ulcer arising from an unerupted lower third molar. She was prescribed a topical steroid and chlorhexidine mouthwash. Reviewing the patient one week later with no signs of healing and progressive trismus and dysphagia, she was referred to us for further management.

Extra oral examination revealed a tender, hard, enlarged right jugulodigastric and submandibular lymph nodes. Intraoral examination demonstrated a coated tongue, a tender, indurated erosive endophytic ulcer 2 × 3 cm on the left lateral border of the tongue and deviation of the tongue to the left side. She complained of intolerance to hot and spicy food and hoarseness in her voice. Clinical diagnosis was confirmed histopathologically as moderately differentiated squamous cell carcinoma of the tongue.

The aetiology of oral cancer in younger adults remains unclear; however, one needs to ponder on the ubiquitous human papilloma virus (HPV). Oral cancers hidden in cryptic locations of the oral cavity, mimicking symptoms in the initial stages, such as those of pericoronitis and tonsillitis, often confront clinicians with the daunting task of managing them in advanced stages. Thinking outside the box with an early diagnosis and swift referral is key before these tumours progress. In this patient, an early marriage followed by early coitus might have triggered the dormant HPV.1 HPV-induced oral cancer known for its demographic shift may be an emerging and distinct clinical entity, although future research is necessary.

Figure 1
figure 1

A single non-healing erythematous endophytic ulcer involving the left lateral border of the tongue and floor of the mouth

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Figure 2: Axial CECT shows a large left-side tongue base carcinoma.
figure 2

Note the extension approximating the midline and the ipsilateral enlarged jugulodigastric node

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