My boyfriend's tongue often looks like it is peeling. His tongue gets really white, and you can see it peeling. Is this a sign of cancer?

V.

This is one of those questions where "a picture is worth a thousand words." I'll take a stab at trying to answer this, based on my guess as to what you mean by "peeling," but one quick look from a doctor would be far more valuable than my hunches and guesses. Make him see a doctor.

My interpretation of "peeling" is that white patches are flaking off the top surface of his tongue. We commonly see this in people who smoke and/or drink alcohol, or in people who use oxidizing mouthwashes (washes that contain hydrogen peroxide, for example), but it can also occur without any provocation. If it is accompanied by bad breath or a bad taste, he may want to buy a tongue scraper (many drug stores carry these) and use it daily. Some folks prefer to brush their tongues when they brush their teeth.

Tongue cancer usually arises from the sides or tip of the tongue, or from the undersurface of the tongue. Only rarely does cancer arise from the top surface of the tongue (the part with taste buds). However, if your boyfriend has a single region that is "white and peeling," this could certainly be a sign of cancer, particularly if this region is on the side, tip or undersurface of his tongue.

Risk factors for tongue cancer include use of tobacco (especially chewing tobacco) and alcohol, and the two together are even worse. Time is important in two ways. Tongue cancer is more common in older individuals. Tongue cancer is also more common in individuals who have been smoking/drinking for longer time periods. The amount of tobacco and alcohol consumed is also important and is directly related to cancer risk. Other risk factors are poor oral hygiene, tongue infection with syphilis (syphilitic glossitis), cirrhosis of the liver, and Plummer-Vinson syndrome (an uncommon iron deficiency syndrome characterized by anemia, oral lesions, "spoon" fingernails and esophageal webs).

The most common symptoms of tongue cancer are tongue pain, a lump or ulcer on the tongue, difficulty or pain with eating, and a lump in the neck (due to spread of the cancer to neck lymph nodes). Tongue cancer is deadly, so early diagnosis is essential to ensure the best chances of survival!

We've previously discussed the treatment options for tongue cancer. If you read this earlier article, you will learn that treatment for tongue cancer can be quite maiming. This, I hope, will emphasize the urgency of early diagnosis and treatment.