Synchronous benign and malignant lesions involving adjacent subsites of the oral cavity are uncommon and may create diagnostic uncertainty. We report a rare case of lower lip squamous cell carcinoma occurring concomitantly with verruca vulgaris of the tongue. A 50-year-old man presented with a 6-year history of a progressively enlarging, painful, ulcerative lower lip lesion with occasional bleeding, and a separate 6-month history of a whitish lesion on the right ventrolateral tongue. He had a history of tobacco use, alcohol use, and multiple sexual partners. Incisional biopsies revealed squamous cell carcinoma of the lower lip and verruca vulgaris of the tongue. Contrast-enhanced computed tomography demonstrated an enhancing lower lip mass with cervical lymphadenopathy. The patient underwent wide excision of the lower lip-to-left buccal mucosa mass with intraoperative frozen-section margin assessment, reconstruction with an anterolateral thigh flap, bilateral modified radical neck dissection (levels I-IV), and wide excision of the tongue lesion. Histopathologic examination confirmed the diagnoses. The coexistence of a malignant lower lip lesion and a benign verrucous tongue lesion is rare and can mimic other premalignant, infectious, and proliferative oral lesions. Thorough clinical evaluation, histopathologic confirmation, and appropriate imaging are essential for accurate diagnosis and treatment planning. Concomitant lower lip squamous cell carcinoma and tongue verruca vulgaris is an unusual presentation. Separate lesions within the oral cavity should be evaluated independently, and biopsy should be considered to avoid diagnostic error and guide timely management.
Chan et al. (2026) studied this question.