It may start as a small ulcer, usually on the lateral border of the anterior two third of the tongue. It may have varied presentation like a small papillary exophytic lesion, a flat nodule, ulceration within a pre existing fissure or may occur in the absence of frank ulceration in an atrophic tongue. Once ulceration has occurred, the lesion becomes painful, making speech and swallowing difficult. Tongue cancer rapidly extends to involve the floor of the mouth and lower alveolus, which makes treatment difficult.