Background & Aim: Chronic, non-healing oral ulcers often straddle the fine line between benign reactive lesions and malignancies. Such lesions merit vigilant evaluation. This case series delineates two confounding clinical scenarios, initially suspected as oral squamous cell carcinoma (OSCC), which were later histologically diagnosed as Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE), enhancing the pivotal role of biopsy in averting misdiagnosis.

Case Overview: Two geriatric patients presented with persistent, painful ulcerative lesions on the lateral tongue for over 7–9 months. Clinically mimicking malignancy, both lesions exhibited induration and proliferative features. Histopathological examination post-excisional biopsy confirmed TUGSE. Conservative surgical management resulted in complete healing within two months, with no recurrence.

Conclusions: Clinicians must maintain a high index of suspicion and consider TUGSE in the differential diagnosis of persistent oral ulcers. Timely histological confirmation can prevent aggressive over treatment and offer immense psychological relief to the patient.

Clinical Significance: Despite its alarming appearance, TUGSE is a benign, self-resolving entity. Its close resemblance to OSCC mandates careful clinical and histological assessment to ensure appropriate therapeutic decisions.