Cocaine abuse and the consequent prevalence of the damage associated with it have increased in the global population. The damage depends on the route of administration, where an important sequel of snorting is perforation of the nasal septum and palate. Necrosis of the palate, meanwhile, is also the manifestation of other diseases such as tertiary syphilis, necrotizing sialometaplasia and malignant neoplasms. The differential diagnosis of such lesions is important for determining appropriate treatment. A case of an ulcerated lesion in the palate of a cocaine-using patient whose diagnosis was necrotizing sialometaplasia is reported.