Where should you look for malignancies in the mouth for a patient with tobacco use?

• A. Under the tongue
• B. On the sides of the mouth
• C. On the hard palate
• D. Just anterior to the uvula

Answer: (A)

The floor of the mouth beneath the tongue is a high‑yield area to inspect in tobacco users because this mucosa is directly exposed to the carcinogens in tobacco and is relatively thin, making lesions easier to develop and detect there. Cancers in this region (tongue underside and floor of the mouth) often present as a nonhealing ulcer, a firm indurated lump, or a red or white patch, and they can spread quickly through the nearby lymphatics. When examining, lift the tongue to view the underside and floor, feel for any fixed masses, and look for persistent lesions beyond two weeks. While cancers can occur in other parts of the mouth, the under-tongue region is the most common site to scrutinize first in patients who use tobacco.