Dental MCQ
Catching cancer early · Oral Pathology · INBDE Patient Cases

Oral Cancer & Premalignancy INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on oral cancer & premalignancy. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

7 patient cases35 linked questionsADA INBDE formatFull distractor explanations

Seven ADA INBDE-format patient cases on oral cancer and premalignancy: a non-healing indurated floor-of-mouth ulcer and metastatic neck node in a heavy smoker and drinker (squamous cell carcinoma), leukoplakia and biopsy to grade epithelial dysplasia, erythroplakia and its higher malignant potential, actinic cheilitis and sun-related lower lip squamous cell carcinoma, smokeless tobacco keratosis and the verrucous carcinoma risk, the oral cancer screening examination with tobacco and alcohol cessation and HPV-vaccine counseling, and oral submucous fibrosis from areca (betel) nut. Topics include the premalignant lesions, oral squamous cell carcinoma and its high-risk sites, the tobacco, alcohol, HPV, sun, and betel-nut risk factors, field cancerization, and biopsy as the definitive diagnosis.

Case Coverage Map
What each case is testing
A non-healing ulcer in a smoker who drinks:
Squamous cell carcinoma, induration and high-risk sites, the metastatic neck node, biopsy/referral, and cessation with surveillance.
A white patch that won't rub off:
Leukoplakia, biopsy to grade dysplasia, the meaning of severe dysplasia, worrying changes, and ongoing surveillance.
A red velvety patch:
Erythroplakia and its higher malignant potential, prompt biopsy, the red-over-white risk lesson, and tobacco/alcohol risk.
A weathered lower lip in an outdoor worker:
Actinic cheilitis as premalignant sun damage, biopsy of an indurated focus, lip sun protection, and lip SCC.
A white wrinkled area where the dip sits:
Smokeless tobacco keratosis, its cancer (including verrucous) risk, cessation, biopsy if persistent/indurated, and counseling.
A screening exam for a long-time smoker:
The oral cancer screening examination, synergistic tobacco-alcohol risk, cessation support, continued screening, and HPV vaccination.
Tight cheeks and limited opening with areca nut use:
Oral submucous fibrosis from areca/betel nut, its premalignant potential, habit cessation, and the trismus that complicates care.
Patient case: A non-healing ulcer in a smoker who drinks
0 of 5 answered, 0 correct
Patient
Male, 61 years old
Chief Complaint
"I have a sore under my tongue that won't go away."
Background and/or Patient History
  • A non-healing ulcer present for about six weeks
  • Long history of cigarette smoking and regular heavy alcohol use
  • Mild discomfort, no obvious cause for the sore
  • Has not seen a dentist in years
Allergies
NKDA
Medications
  • None
Current Findings
  • An indurated ulcer with rolled borders on the floor of the mouth / ventral tongue
  • A firm, non-tender node palpable in the neck
  1. Question 1
    Moderate
    The non-healing, indurated ulcer in this high-risk patient is most concerning for:
  2. Question 2
    Moderate
    The location of this lesion is significant because the floor of mouth and ventral tongue are:
  3. Question 3
    Hard
    The firm, non-tender neck node most likely represents:
  4. Question 4
    Moderate
    The definitive diagnostic step is to:
  5. Question 5
    Moderate
    Beyond treating this lesion, the patient should receive:

Reset this case?

This clears your answers for this patient case only.

Patient case: A white patch that won't rub off
0 of 5 answered, 0 correct
Patient
Male, 58 years old
Chief Complaint
"There's a white patch in my mouth that has been there for a while."
Background and/or Patient History
  • A persistent white patch on the lateral tongue
  • Former smoker
  • The patch cannot be wiped off
  • No pain
Allergies
NKDA
Medications
  • None
Current Findings
  • A well-demarcated white plaque that does not wipe away
  • No induration noted today
  1. Question 1
    Moderate
    A white patch that cannot be wiped off and has no other explanation is termed:
  2. Question 2
    Moderate
    The appropriate management of this lesion is to:
  3. Question 3
    Hard
    If the biopsy shows severe epithelial dysplasia, this indicates:
  4. Question 4
    Moderate
    Which finding on a white lesion would increase concern for malignant change?
  5. Question 5
    Moderate
    Even after this lesion is managed, the former smoker should be advised that:

Reset this case?

This clears your answers for this patient case only.

Patient case: A red velvety patch
0 of 5 answered, 0 correct
Patient
Female, 64 years old
Chief Complaint
"My dentist noticed a red area on the floor of my mouth."
Background and/or Patient History
  • An asymptomatic red, velvety patch found on examination
  • History of smoking and social drinking
  • No pain or obvious cause
  • Patch has been present for at least a month
Allergies
NKDA
Medications
  • None
Current Findings
  • A well-defined red, velvety patch on the floor of the mouth
  • No wipeable component
  1. Question 1
    Moderate
    A red, velvety patch with no other explanation is termed:
  2. Question 2
    Moderate
    Compared with leukoplakia, this red patch is generally:
  3. Question 3
    Moderate
    The appropriate next step is to:
  4. Question 4
    Moderate
    A practical teaching point from this case is that, in oral premalignancy:
  5. Question 5
    Moderate
    Her smoking and drinking history is relevant because these exposures:

Reset this case?

This clears your answers for this patient case only.

Patient case: A weathered lower lip in an outdoor worker
0 of 5 answered, 0 correct
Patient
Male, 59 years old
Chief Complaint
"My bottom lip is rough and the border looks blurry."
Background and/or Patient History
  • Decades of outdoor work with heavy sun exposure
  • Lower lip is dry, scaly, with a blurred vermilion border
  • A persistent rough area that does not fully heal
  • Fair skin
Allergies
NKDA
Medications
  • None
Current Findings
  • Diffuse scaling and loss of the sharp vermilion-skin border on the lower lip
  • A focal indurated rough patch within the area
  1. Question 1
    Moderate
    The diffuse scaly change with a blurred vermilion border on a sun-exposed lower lip is:
  2. Question 2
    Moderate
    The significance of actinic cheilitis is that it:
  3. Question 3
    Moderate
    The focal indurated rough patch within the field should be:
  4. Question 4
    Moderate
    Key preventive advice for this patient is:
  5. Question 5
    Moderate
    This case reinforces that the lower lip is the classic site for:

Reset this case?

This clears your answers for this patient case only.

Patient case: A white wrinkled area where the dip sits
0 of 5 answered, 0 correct
Patient
Male, 27 years old
Chief Complaint
"There's a white, wrinkly patch where I hold my chewing tobacco."
Background and/or Patient History
  • Uses smokeless (dipping) tobacco daily for years
  • A white, wrinkled change in the lower labial vestibule where the product sits
  • No pain
  • Otherwise healthy
Allergies
NKDA
Medications
  • None
Current Findings
  • A grey-white, wrinkled (corrugated) mucosal change in the mandibular vestibule
  • Gingival recession adjacent to the site
  1. Question 1
    Moderate
    The white wrinkled change localized to where smokeless tobacco is held is:
  2. Question 2
    Moderate
    Smokeless tobacco use is associated with which malignancy in particular?
  3. Question 3
    Moderate
    The single most important intervention for this patient is to:
  4. Question 4
    Moderate
    If the lesion persists or becomes indurated despite cessation, the dentist should:
  5. Question 5
    Moderate
    An accurate counseling point about smokeless tobacco is that it is:

Reset this case?

This clears your answers for this patient case only.

Patient case: A screening exam for a long-time smoker
0 of 5 answered, 0 correct
Patient
Female, 55 years old
Chief Complaint
"I'm here for a checkup. I've smoked for 30 years."
Background and/or Patient History
  • Long-term smoker, also drinks alcohol regularly
  • Asymptomatic, no specific complaint
  • Has never had an oral cancer screening explained
  • Open to quitting
Allergies
NKDA
Medications
  • None
Current Findings
  • No suspicious lesion found today on a thorough exam
  • Heavy tobacco and alcohol history
  1. Question 1
    Moderate
    A thorough oral cancer screening examination should include:
  2. Question 2
    Moderate
    Because she both smokes and drinks, her oral cancer risk is:
  3. Question 3
    Moderate
    The most valuable preventive intervention to offer is:
  4. Question 4
    Moderate
    Even though no lesion was found today, she should be advised that:
  5. Question 5
    Moderate
    Counseling her about HPV vaccination is reasonable because the vaccine:

Reset this case?

This clears your answers for this patient case only.

Patient case: Tight cheeks and limited opening with areca nut use
0 of 5 answered, 0 correct
Patient
Male, 40 years old
Chief Complaint
"My mouth feels stiff and I can't open as wide as I used to."
Background and/or Patient History
  • Regular betel quid / areca nut chewing for many years
  • Progressive stiffness of the cheeks and reduced mouth opening
  • A burning sensation with spicy food
  • Recently immigrated, common habit in his community
Allergies
NKDA
Medications
  • None
Current Findings
  • Pale, firm, fibrotic buccal mucosa with palpable fibrous bands
  • Limited mouth opening (trismus)
  1. Question 1
    Moderate
    Progressive mucosal stiffness and limited opening in a long-term areca nut user suggests:
  2. Question 2
    Moderate
    The principal cause is:
  3. Question 3
    Hard
    The major long-term concern with oral submucous fibrosis is that it is:
  4. Question 4
    Moderate
    An essential part of management is to:
  5. Question 5
    Moderate
    His limited mouth opening is also relevant to dental care because it:

Reset this case?

This clears your answers for this patient case only.

Keep studying
Oral Cancer & Premalignancy core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

← Back to Oral Cancer & Premalignancy