A farmer presents with a sore on his lower lip, which is ulcerated in the center with rolled, raised borders. What is the likely diagnosis?

• A. Angular cheilitis
• B. Syphilis
• C. Herpes labialis
• D. Squamous cell carcinoma

Answer: (D)

The presentation of a sore on the lower lip that is ulcerated in the center with rolled, raised borders is highly indicative of squamous cell carcinoma (SCC). This type of carcinoma often appears as a non-healing ulcer or sore, which may have a characteristic appearance with distinct borders. The rolled or raised edges around the ulcer can suggest deeper tissue involvement and potential for malignancy, rather than benign conditions.

In contrast, angular cheilitis usually presents at the corners of the mouth and typically shows fissures or cracks rather than an ulcer with rolled borders. Syphilis can manifest with oral lesions, known as mucous membrane lesions, but these typically do not have the rolled borders characteristic of SCC. Herpes labialis, on the other hand, tends to present as vesicular lesions that can rupture, leading to crusting, but this clinical presentation is different from the described characteristics of the ulcer.

Therefore, the combination of an ulcerated sore with specific features strongly suggests squamous cell carcinoma as the most likely diagnosis in this case.