It is important to inspect the mouth for the appearance of the lesion, its location and any effect on adjacent tissues. Radiographs may be necessary to establish the tumor effect on adjacent bone. Although cytology was commonly used to diagnose oral cancer in the past, difficulties with its interpretation and reliability have greatly reduced its usefulness. If oral cancer is suspected, then the most appropriate test is a tissue biopsy of the lesion.6 In most instances a biopsy of a suspicious lesion can be undertaken using local anesthesia. It is important that the biopsy is large enough and representative of the lesion. For most lesions it is appropriate to sample the center of the lesion and ensure that it is deep enough to include connective tissue at the base.