Ulcer for more than 3 weeks
A sore in the mouth or on the cheek does not heal for more than 3 weeks and there is no clear reason - for example, a sharp tooth or a denture that rubs.
CONDITION / JAWS, MOUTH AND NECK
Tumors of the oral cavity and cheeks.
Tumors of the oral cavity and cheeks are neoplasms on the mucous membrane of the cheek, gums, tongue, floor of the mouth or lips. Bumps and spots in the mouth are often not cancerous, but an ulcer that does not heal for more than 3 weeks, a bump or a red spot should be seen by a doctor without delay: these may be early signs of mouth cancer.
CONCEPTUAL VISUALIZATION- What it is
- Neoplasm of the mucous membrane of the mouth or cheek; the most common malignant tumor here is squamous cell carcinoma.
- Alarming signs
- An ulcer that does not heal for more than 3 weeks; lump; red or white spot.
- Diagnosis
- It is confirmed by a biopsy — examination of the tissue under a microscope.
- Who treats it
- A team of specialists: a surgeon removes and restores tissues, an oncologist conducts the rest of the treatment.
01 / WHAT IS ITWhat is
What is
mouth and cheek tumors.
A tumor in the mouth is a neoplasm on the mucous membrane of the cheek, gums, tongue, floor of the mouth, palate or lips. Such changes are very common and often have other, non-cancerous causes. Benign formations — papillomas, fibromas, vascular nodules — are described on the next page.
The most common malignant tumor of the mouth is squamous cell carcinoma. It is often preceded by potentially malignant changes in the mucous membrane: a white spot (leukoplakia) or a red spot (erythroplakia). In a review of 55 studies, 6.64% of leukoplakias progressed to cancer, and in a review of 92 studies, 33.1% of erythroplakias developed.
Oral cancer in its early stages can look like an ordinary ulcer. Therefore, the main thing is not the spots or lumps themselves, but to know the signs with which they should be shown to the doctor, and not to postpone the biopsy. If cancer is found early, it may be easier to treat.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhat are the signs?
What are the signs?
cannot be postponed.
Such signs often occur in other conditions, and they do not yet mean cancer. But each of them should be shown to a doctor or dentist.
A red or white spot
A spot on the mucous membrane that does not go away. A red or red-white spot should be shown to the dentist urgently, without waiting for a scheduled appointment.
Precancerous changes of the skin and lipsA lump in the mouth or on the lip
Seals on the cheek, gums, tongue or lip. It is often benign, but it can be determined for sure only after an examination, and often a biopsy.
Benign neoplasms of the mouthA lump on the neck
A knot on the neck that does not go away and the cause of which is unclear is a reason for an examination without delay.
Neoplasm of the neckPain and swallowing
Pain in the mouth that does not go away; swallowing or speaking gradually becomes more difficult; the voice is hoarse and does not recover.
Weight loss
Weight comes off, even though you haven't tried to lose weight.
03 / REASONSWhat increases
What increases
risk of oral cancer.
The exact cause of oral cancer is not always clear. But there are factors with which it happens more often, and some of them can be changed.
Tobacco and alcohol
Smoking, chewing tobacco, betel or pan, and drinking a lot of alcohol increase the risk. Quitting smoking and drinking less alcohol can reduce the chance of getting the disease.
A white or red spot
Not every such spot becomes cancer. But in a review of 55 studies (41,231 people with leukoplakia), the risk was higher in non-uniform and large patches, on the side of the tongue, in smokers and when dysplasia, a change in cells, was found under a microscope.
Precancerous changesImmunity and cancer in the past
The risk is higher if the immune system is weakened—due to HIV or immune-suppressing drugs—or if the cancer has already occurred.
Virus and genes
Oral cancer has also been linked to changes in genes and to certain types of human papillomavirus (HPV) in the mouth. About HPV and papillomas - on the next page.
Papillomas in the mouth
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Suspicion of a tumor in the mouth usually does not require emergency care, but you can't wait for months either. An ambulance is needed if it becomes difficult to breathe, there is severe swelling or bleeding, especially after surgery.
103 immediately if:
- it is difficult to breathe;
- it suddenly became difficult to speak or swallow;
- severe swelling appeared in the mouth or neck;
- bleeding from the mouth does not stop;
- the blood spurts, bright red and hard to stop.
See a doctor without delay if:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after surgery in the mouth or on the neck, pain or swelling increases, the wound is red or pus is released from it, a high temperature has appeared. Without delay - to the doctor or dentist: a mouth ulcer that does not heal for more than 3 weeks and the cause is unclear or there is a lump on the neck that does not go away. Don't expect it to go away. Urgently, without waiting for a scheduled appointment, to a dentist or maxillofacial surgeon: a lump on the lip or in the mouth; a red or red-white spot in the mouth. In the near future - to a doctor or dentist: a white spot that does not go away; pain in the mouth that does not go away; swallowing or speaking gradually becomes more difficult; the voice is hoarse and does not recover; weight decreases for no reason.
05 / DIAGNOSTICSHow they check
How they check
suspicious change.
- Review
The doctor or dentist examines and feels the mouth, cheeks, tongue, as well as the neck and jaw.
- Biopsy
A piece of tissue is examined under a microscope. This is the main way to confirm or rule out cancer: according to a Cochrane review (63 studies), no ancillary test - dye, smear or light - replaces a biopsy.
- Pictures
X-ray, ultrasound, CT or MRI, and if necessary, other examinations show how far the tumor has spread.
- Consilium
If the diagnosis is confirmed, the treatment plan is drawn up by a group of specialists: a surgeon, an oncologist and a radiation therapist.
06 / TREATMENTHow we treat
How we treat
tumors of the mouth.
Treatment depends on what the biopsy shows, where the tumor is, what size it is, and whether the lymph nodes are affected. Benign formations are removed and examined under a microscope; below - about cancer.
01
Surgery
According to British national guidelines, surgery is the mainstay of oral cancer treatment.
- Tumor removal
- The tumor is removed together with a reserve of healthy tissue - according to the guidelines, about 1 cm, if there are no important structures nearby.
- Neck lymph nodes
- The guideline recommends treating the neck for all tumors of the oral cavity. In a randomized trial of 500 patients with early oral cancer, 80.0% of those who had lymph nodes removed immediately were alive at 3 years, compared with 67.5% in the observation group; adverse events — 6.6% versus 3.6%.
- Cheek cancer
- In a cohort of 70 patients with buccal mucosal cancer, the five-year survival rate was 69%. The authors believe that it is enough to remove an early tumor widely through the mouth, and for an advanced one, combine methods and remove neck lymph nodes.
02
Recovery after deletion
To regain speech, swallowing and mouth opening.
- Free flaps
- Large defects in the mouth are often covered with tissues from other parts of the body on their own vessels. In a series of 161 patients, the flap took root in 97.4% (from the forearm) and 97.8% (from the thigh); the thigh flap was larger in area.
- Opening the mouth
- After surgery on the cheek, it may be limited. In a cohort of 312 patients, 31.4% had it after 12 months; the risk was higher with a deep tumor, masticatory muscle removal, a defect of 15 cm² or more, and irradiation of 60 Gy or more.
03
Treatment after surgery
- Radiation and chemotherapy
- If the lymph nodes of the neck are significantly affected or tumor cells are found at the edges of the removed tissue, a combination of radiation and chemotherapy is recommended to improve disease control. They are prescribed by an oncologist.
- Neck complications
- After removal of neck lymph nodes, according to a review of 15 studies, wound infection occurred in 7.1%, bleeding or hematoma occurred in 5.2%.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Tumors of the oral cavity and cheeks at Dr. Valikhnovskyi's Institute of Surgery are part of the "New Face" direction: tissues are restored here after tumor removal. Reconstruction is often done in one operation with removal, if the edges of the incision are clean; otherwise - after histology. In the case of cancer, the plan is drawn up together with an oncologist and a radiation therapist: the clinic is responsible for its part - removal and recovery, and chemotherapy and radiation therapy and oncological supervision are conducted by the oncologist.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Reconstruction in one operation — if the edges of the incision are clean, the defect is restored immediately after the removal of the tumor; if not, after histology.
- Radial forearm flap — a thin and flexible flap on its own vessels, which restores the mucous membrane, cheeks, floor of the mouth, tongue and lips.
- Anterolateral thigh flap — for large and deep defects; the ultra-thin version is less bulky.
- Fibula flap — if a part of the jaw is removed together with the tumor: the leg bone with vessels is folded into the shape of the jaw according to a 3D template.
- Virtual planning and 3D printing — if a part of the jaw is removed, the new bone is modeled in advance using a CT scan and templates for cutting are printed.
- Local patches - small defects of the lips and cheeks are closed with a nasolabial or cervical-facial flap - the skin is similar in color and thickness.
- Rehabilitation of mouth opening — exercises together with a device for developing the jaw after treatment for head and neck cancer.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photos and documents onlineSend a photo of changes in the mouth, results of a biopsy, CT or MRI, if they are available - the doctor will pre-evaluate the situation.
- ConsultationExamination of the mouth and neck; if a biopsy has not yet been done, a plan for how to do it.
- Joint planThe surgeon, oncologist and radiation therapist decide what to do and in what order.
- SurgeryRemoval and reconstruction — if possible, in one operation.
- Recovery and supervisionAfter operations on the jaw, food is soft or liquid for a while; exercises for opening the mouth; then - regular check-ups with an oncologist.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is every mouth ulcer cancer?
No. Mouth sores, spots, and ulcers often have other causes. But an ulcer that does not heal for more than 3 weeks should be seen by a doctor or dentist.
Can cancer be diagnosed without a biopsy?
No. Staining, smearing or light can help, but none of these tests replace a biopsy with tissue examination, according to a Cochrane review.
Does a white spot turn into cancer?
This is possible, but not always. In a review of 55 studies, 6.64% of leukoplakia turned into cancer; the risk is higher in large heterogeneous spots, on the lateral edge of the tongue, and in smokers.
Why remove lymph nodes if they are not enlarged?
In a randomized trial of 500 patients with early oral cancer after simultaneous removal of lymph nodes, the 3-year survival rate was 80.0% versus 67.5% at follow-up. Decisions are made based on the size and location of the tumor.
Is it possible to restore the cheek after tumor removal?
Yes. The defect is closed with local tissues or a flap from another part of the body. In a series of 161 patients, flaps in the mouth took root in 97.4–97.8%.
Will I be able to open my mouth normally?
Restriction is possible. In a cohort of 312 patients after cheek surgery, 31.4% had it one year later. The risk is higher with a deep tumor, a large defect, and radiation; how to reduce it, the doctor will explain before the operation.
Does it hurt if I delay the visit a bit?
Studies on the effect of delay on survival are mixed. But in a review of 13 studies, the main reason for late diagnosis was that people don't know enough about early signs. Therefore, it is better to show an ulcer for more than 3 weeks or a goiter without delay.
Sources
18 sources · NICE and UK guidelines, reviews and researchshowCollapse
- Oral cavity and lip cancer: United Kingdom National Multidisciplinary GuidelinesJournal of Laryngology & Otology, 2016doi:10.1017/S0022215116000499 ↗
- Oral potentially malignant disorders: A consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral CancerOral Diseases, 2021doi:10.1111/odi.13704 ↗
- Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesionsCochrane Database of Systematic Reviews, 2021doi:10.1002/14651858.CD010276.pub3 ↗
- Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysisOral Diseases, 2025doi:10.1111/odi.15140 ↗
- Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtypeHead & Neck, 2020doi:10.1002/hed.26006 ↗
- Delay in diagnosis of oral cancer: a systematic reviewMedicina Oral, Patología Oral y Cirugía Bucal, 2021doi:10.4317/medoral.24808 ↗
- Impact of delay in diagnosis and treatment-initiation on disease stage and survival in oral cavity cancer: a systematic reviewActa Oncologica, 2021doi:10.1080/0284186X.2021.1931712 ↗
- Elective versus Therapeutic Neck Dissection in Node-Negative Oral CancerNew England Journal of Medicine, 2015doi:10.1056/NEJMoa1506007 ↗
- Squamous cell carcinoma of the buccal mucosa: outcomes of treatment in the modern eraLaryngoscope, 2012doi:10.1002/lary.23296 ↗
- Postoperative complications of neck dissection for head and neck squamous cell carcinoma: a systematic review and meta-analysisOral Oncology, 2025doi:10.1016/j.oraloncology.2025.107430 ↗
- Microsurgical reconstruction of the oral cavity with free flaps from the anterolateral thigh and the radial forearm: a comparison of perioperative data from 161 casesAnnals of Surgical Oncology, 2011doi:10.1245/s10434-011-1584-8 ↗
- Risk factor analysis and development of a prediction model for trismus after surgical treatment of buccal mucosa squamous cell carcinomaBMC Oral Health, 2026doi:10.1186/s12903-026-09352-w ↗
- Suspected cancer: recognition and referral (NG12) — recommendations organised by site of cancerNICE, 2026nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer ↗
- Suspected cancer: recognition and referral (NG12) — terms used in this guidelineNICE, 2026nice.org.uk/guidance/ng12/chapter/Terms-used-in-this-guideline ↗
- Mouth cancer: symptomsNHS, 2023nhs.uk/conditions/mouth-cancer/symptoms ↗
- Mouth cancer: causesNHS, 2023nhs.uk/conditions/mouth-cancer/causes ↗
- Dental abscessNHS, 2026nhs.uk/conditions/dental-abscess ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
Ulcer or lump
does not pass in the mouth?
Send photos and test results, if available. The doctor will tell you what tests are needed and how to restore tissues after treatment.