A 58-year-old man presented to the emergency department with a persistent left-sided sore throat of 2-month duration. The sore throat had not responded to antibiotic therapy. Over the past week, the soreness had increased and was aggravated by opening the mouth. He denied fever but admitted to a 10-lb weight loss. His social history was significant for alcohol and tobacco use. Physical examination revealed a bulging and erythematous left soft palate with a deviated uvula. Areas of the tonsil were noted to be ulcerating through the soft palate. In the upper left neck, a 3-cm, firm, nontender, lymph node was palpated anterior to the sternocleidomastoid muscle. A computed tomography of the neck with contrast revealed an enhancing tonsillar mass as well as enlarged lymph nodes bilaterally. A transoral biopsy returned squamous cell carcinoma.
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