Smokeless Tobacco Lesions Clinical Presentation

  • Author: Carol E Cheng; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 5, 2010
 

History

Patients may present asymptomatically, admitting only to the use of smokeless tobacco or to the presence of other predisposing risk factors (eg, use of alcohol, exposure to chronic irritants) for premalignant and cancerous lesions. In more advanced disease, patients may report pain, swelling, or dysphagia.

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Physical

Leukoplakia

Leukoplakia refers to a filmy white or yellow patch involving the oral mucosa. The patch may appear translucent or opaque and raised or ulcerated. It may be pumicelike. Leukoplakia is a clinically descriptive term, and other diseases must be ruled out.

Erythroplasia

Erythroplasia appears as a patch with varying degrees of erythema. It most commonly occurs on the floor of the mouth.

Speckled leukoplakia

The lesions are white patches with interspersed areas of erythema. Two thirds of the lesions are located on the buccal mucosa; the tumors are commonly nodular.

Tobacco-associated keratosis

Tobacco-associated keratosis is an ill-defined area of white thickening at the sites where oral smokeless tobacco is habitually placed; most commonly, these areas involve the mandibular labial and buccal mucosal folds. The continued use of smokeless tobacco causes the affected areas to become corrugated and grayer.

Verrucous carcinoma

The lesions appear as exophytic growths with papillary projections, they may be large at the time of diagnosis, and they can cause local tissue destruction. They appear rough surfaced with a broad-base attachment.

Squamous cell carcinoma

The lesions usually have a mixed red and white appearance, with ulceration or inflammation in some cases. The lesions are most commonly found on the floor of the mouth and on the ventral and lateral surfaces of the tongue. Those cancers associated with smokeless tobacco may arise in differing locations associated with quid placement and/or the buccal folds. Swelling or induration is characteristic of invasive growth.

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Causes

Alcohol consumption, cigarette smoking, candidal infection, and poor dentition are causes of oropharyngeal cancers. Additionally, human papillomavirus (HPV), especially HPV type 16, has been implicated in the pathogenesis of 20-30% of oropharyngeal cancers. People with HPV-related oral cancers seem to have a better prognosis than those without HPV infection, and they are less likely to have a history of tobacco and alcohol use. Finally, exposure to chronic irritants (eg, mouthwash, poorly fitting dentures) may be associated with oral mucosal cancer.

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Contributor Information and Disclosures
Author

Carol E Cheng  Boston University School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Maryanne Makredes, MD  Resident Physician, Division of Dermatology, University of Massachusetts Medical Center

Maryanne Makredes, MD, is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Alexa F Boer Kimball, MD, MPH  Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital

Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Jacek C Szepietowski, MD, PhD  Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Stiefel GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Verrucous carcinoma.
Oral leukoplakia.
 
 
 
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