Smoker with dysplasia

55-year-old female patient with partial edentulism, dental caries and consumption of 20 cigarettes a day, presented with, a whitish lesion on the ventral face of the tongue, since three years. It was not painful, slightly rough to the touch, hyperkeratotic, which does not disappear with scraping, one centimeter in diameter and whitish coloration of the mucosa of the floor of the mouth. Given that the lesion appears to be inhomogeneous, a biopsy is performed that reveals "squamous mucosa with foci of moderate and severe lingual dysplasia of the floor of the mouth", with the presence of the human papillomavirus type 16. The location of the lesion makes surgical treatment difficult, deciding to closely monitor the patient; During the following 3 months, the lesion begins to grow and a new biopsy is performed, in which "high-grade intraepithelial dysplasia" is detected.