Squamous cell carcinoma (SCC) is the most common oral malignancy, commonly located on the anterior floor of the mouth, lateral borders of the tongue, tonsillar pillars and lateral soft palate. A 59 year old male presented to a Midwestern university dental hygiene clinic following referral for pre-radiation and chemotherapy oral prophylaxis and comprehensive examination. He reported he found a firm lump in his neck and brought it to the attention of his general physician. Biopsy confirmed the diagnosis of SCC of the left tonsil. Surgery, radiation and chemotherapy were performed. This case study demonstrates the need to include careful palpation of lymph nodes in every intra- and extra-oral examination. Dental hygienists should document significant findings and notify the dentist of abnormalities and the need for subsequent referral, providing early detection results in improved prognosis for those who encounter experiences with oral, head and neck cancer.