Tuberculous lesions are uncommon in the mouth and are usually secondary to open pulmonary tuberculosis. A tuberculous ulcer is the usual presentation, the dorsal surface of the tongue being the typical site1. The ulcer tends to be single, painful, and characteristically has irregular, undermined edges and a friable, granular floor. Microscopy shows the corium to be infiltrated by epithelioid granulomas with moderate numbers of Langhans giant cells (Figures 5.1 and 5.2). Extensive caseation is uncommon and it is unusual for tubercle bacilli to be identified either by Ziehl-Neelsen stain or by immunofluorescent techniques. Chest radiographs and sputum culture are much more likely to lead to definitive diagnosis.