Nonresolving oral candidiasis and squamous cell carcinoma of the tongue: Case report

Background: Candida species are among the most common oral fungal pathogens. Oral Candida infection may obscure the presence of tongue cancer, resulting in delayed diagnosis. Method: Retrospective clinical case review. Results: A 59-year-old man had a white plaque on the left ventral surface of his tongue, noted during a routine dental visit. The plaque was painless and could not be removed by scraping. An incisional biopsy specimen showed hyperplastic candidiasis, and Candida albicans was recovered in culture. The plaque did not resolve despite antifungal treatment. A repeat tongue biopsy at 14 months after the initial biopsy showed mild to moderate epithelial dysplasia and papillary squamous cell carcinoma without invasion (squamous cell carcinoma in situ). Treatment included surgical excision of the carcinoma with wide margins. Follow-up at 7 years showed no recurrence. Conclusions: This case suggests that a high index of suspicion for malignancy is warranted in patients with oral candidal lesions that persist beyond 14 days of systemic antifungal therapy. Close monitoring and repeat biopsy may help minimize delays in cancer diagnosis and treatment.