Tongue lesions in a patient with cancer may represent a number of different disorders. Oral candidiasis, herpes simplex virus infection, and anaerobic stomatitis are the most common cause of oral infections. Chemotherapy- and radiation therapy–induced mucositis is quite common in this population. Some disorders of the oropharynx may be benign and are treated differently from those that may be infectious in nature. Lingua villosa (LV) is one such disease that is very often asymptomatic but may cause decreased oral uptake and aesthetic displeasure. Most treatment options for LV tend to be conservative, such as tongue brushing and improving oral hygiene but are frequently ineffective. We successfully treated our patient with oral beclomethasone, a drug frequently used to manage gastrointestinal graft versus host disease. The topical nature of this corticosteroid with minimal systemic absorption is an ideal alternative for treating LV. We present a case of LV, a common mimic of oral candidiasis and discuss the differential diagnosis and treatment options.