A persistent painful ulcer on the lip

Over a four-week period, a 63-year-old man developed a painful ulcer (1.2 cm diameter) and a smaller satellite ulcer on his lower lip (Figure 1). Over a number of years, he had a history of smaller mouth ulcers which were tender and lasted seven to 10 days before healing. A lip biopsy revealed an ulcer associated with a marked mixed inflammatory reaction with numerous neutrophils, but the adjacent epithelium was not associated with evident atypia or underlying vasculitis (Figure 2).