eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Smokeless Tobacco Lesions: Follow-up

Author: Jacqueline Dolev, MD, Assistant Clinical Professor, Director for the Advancement of Medical Education in Dermatology, Department of Dermatology, University of California, San Francisco Medical Center
Coauthor(s): Maryanne Kazanis, Doris Duke Clinical Research Fellow, Clinical Unit for Research Trials in Skin, Department of Dermatology, Brigham and Women's Hospital; 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
Contributor Information and Disclosures

Updated: Nov 12, 2008

Follow-up

Further Outpatient Care

Persons who use smokeless tobacco should have regular follow-up visits to their physician and dentist for oral examinations.

Inpatient & Outpatient Medications

See Medication.

Deterrence/Prevention

NSTEP, with funding from the Robert Wood Johnson Foundation and other national organizations, advocates the prevention of smokeless tobacco use through education. Additionally, Clinicians should use the "4 A 's" proposed by the National Cancer Institute as outlined in Medical Care.

Prognosis

The prognosis for oral cancer varies greatly with the location and the size of the tumor at the time of diagnosis. The survival rates are 90-100% for small carcinomas in the hard palate, on the upper part of the gingiva, on the floor of the mouth, and on the buccal mucosa. Moderately advanced lesions without spread to the lymph nodes are associated with a local control rate of as much as 80%, whereas posterior cancers that appear late are associated with a survival rate as low as 30%.

Patient Education

Patient handouts regarding smoking cessation techniques and resources (eg, setting a quitting date, group therapy) are available from the National Cancer Institute. Additionally, the National Spit Tobacco Education Program provides patient resources and a list of activities by region.

For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education article Cancer of the Mouth and Throat.

Miscellaneous

Medicolegal Pitfalls

Failure to diagnose a malignant lesion could be a medicolegal issue.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Editor-in-Chief, William James, MD, to the development and writing of this article.



More on Smokeless Tobacco Lesions

Overview: Smokeless Tobacco Lesions
Differential Diagnoses & Workup: Smokeless Tobacco Lesions
Treatment & Medication: Smokeless Tobacco Lesions
Follow-up: Smokeless Tobacco Lesions
Multimedia: Smokeless Tobacco Lesions
References
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References

  1. [Best Evidence] Luo J, Ye W, Zendehdel K, Adami J, Adami HO, Boffetta P, et al. Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Lancet. Jun 16 2007;369(9578):2015-20. [Medline].

  2. Hassan MM, Abbruzzese JL, Bondy ML, Wolff RA, Vauthey JN, Pisters PW, et al. Passive smoking and the use of noncigarette tobacco products in association with risk for pancreatic cancer: a case-control study. Cancer. Jun 15 2007;109(12):2547-56. [Medline].

  3. Boffetta P, Aagnes B, Weiderpass E, Andersen A. Smokeless tobacco use and risk of cancer of the pancreas and other organs. Int J Cancer. May 10 2005;114(6):992-5. [Medline].

  4. Alguacil J, Silverman DT. Smokeless and other noncigarette tobacco use and pancreatic cancer: a case-control study based on direct interviews. Cancer Epidemiol Biomarkers Prev. Jan 2004;13(1):55-8. [Medline].

  5. Centers for Disease Control and Prevention. From the Centers for Disease Control and Prevention. State-specific prevalence among adults of current cigarette smoking and smokeless tobacco use and per capita tax-paid sales of cigarettes--United States, 1997. JAMA. Jan 6 1999;281(1):29-30. [Medline].

  6. Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in U.S. adults: data from the Third National Health and Nutrition Examination Survey, 1988-1994. J Am Dent Assoc. Sep 2004;135(9):1279-86. [Medline].

  7. Ahmed HG, Mahgoob RM. Impact of Toombak dipping in the etiology of oral cancer: gender-exclusive hazard in the Sudan. J Cancer Res Ther. Apr-Jun 2007;3(2):127-30. [Medline].

  8. Scheifele C, Nassar A, Reichart PA. Prevalence of oral cancer and potentially malignant lesions among shammah users in Yemen. Oral Oncol. Jan 2007;43(1):42-50. [Medline].

  9. Martin GC, Brown JP, Eifler CW, Houston GD. Oral leukoplakia status six weeks after cessation of smokeless tobacco use. J Am Dent Assoc. Jul 1999;130(7):945-54. [Medline].

  10. Tilashalski K, Rodu B, Mayfield C. Assessing the nicotine content of smokeless tobacco products. J Am Dent Assoc. May 1994;125(5):590-2, 594. [Medline].

  11. Yildiz D, Liu YS, Ercal N, Armstrong DW. Comparison of pure nicotine- and smokeless tobacco extract-induced toxicities and oxidative stress. Arch Environ Contam Toxicol. Nov 1999;37(4):434-9. [Medline].

  12. Wray A, McGuirt WF. Smokeless tobacco usage associated with oral carcinoma. Incidence, treatment, outcome. Arch Otolaryngol Head Neck Surg. Sep 1993;119(9):929-33. [Medline].

  13. Bolinder G, Alfredsson L, Englund A, de Faire U. Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers. Am J Public Health. Mar 1994;84(3):399-404. [Medline].

  14. Horn KA, Maniar SD, Dino GA, Gao X, Meckstroth RL. Coaches' attitudes toward smokeless tobacco and intentions to intervene with athletes. J Sch Health. Mar 2000;70(3):89-94. [Medline].

  15. National Spit Tabacco Education Program. Available at http://www.nstep.org. Accessed June 20, 2002.

  16. Berigan TR, Deagle EA 3rd. Treatment of smokeless tobacco addiction with bupropion and behavior modification. JAMA. Jan 20 1999;281(3):233. [Medline].

  17. Ayo-Yusuf OA, Swart TJ, Ayo-Yusuf IJ. Prevalence and pattern of snuff dipping in a rural South African population. SADJ. Nov 2000;55(11):610-4. [Medline].

  18. Connolly GN, Winn DM, Hecht SS, Henningfield JE, Walker B Jr, Hoffmann D. The reemergence of smokeless tobacco. N Engl J Med. Apr 17 1986;314(16):1020-7. [Medline].

  19. Framer ER, Hood AF. Pathology of the Skin. Norwalk, Conn: Appleton & Lange; 1990:918-23.

  20. Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin. Jan-Feb 2001;51(1):15-36. [Medline].

  21. Hong WK, Lippman SM, Itri LM, Karp DD, Lee JS, Byers RM, et al. Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med. Sep 20 1990;323(12):795-801. [Medline].

  22. Katz SI, Wolff K. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1998:1309-14.

  23. Mitchell BE, Sobel HL, Alexander MH. The adverse health effects of tobacco and tobacco-related products. Prim Care. Sep 1999;26(3):463-98. [Medline].

  24. National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program. 2001. National Cancer Institute. Available at http://seer.cancer.gov. Accessed June 20, 2002.

  25. Smith SS, Fiore MC. The epidemiology of tobacco use, dependence, and cessation in the United States. Prim Care. Sep 1999;26(3):433-61. [Medline].

  26. Taybos G. Oral changes associated with tobacco use. Am J Med Sci. Oct 2003;326(4):179-82. [Medline].

  27. Tilashalski K, Rodu B, Cole P. A pilot study of smokeless tobacco in smoking cessation. Am J Med. May 1998;104(5):456-8. [Medline].

  28. Wallner PE, Hanks GE, Kramer S, McLean CJ. Patterns of Care Study. Analysis of outcome survey data-anterior two-thirds of tongue and floor of mouth. Am J Clin Oncol. Feb 1986;9(1):50-7. [Medline].

  29. Walsh PM, Epstein JB. The oral effects of smokeless tobacco. J Can Dent Assoc. Jan 2000;66(1):22-5. [Medline].

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Further Reading

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Keywords

oral lesions, premalignant leukoplakia, leukoplakia, speckled leukoplakia, carcinoma in situ, CIS, squamous cell carcinoma, SCC, oral cancer, buccal mucosal cancer, erythroplasia, erythroplakia, tobacco-associated keratosis, verrucous carcinoma, snuff dipper's cancer

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Contributor Information and Disclosures

Author

Jacqueline Dolev, MD, Assistant Clinical Professor, Director for the Advancement of Medical Education in Dermatology, Department of Dermatology, University of California, San Francisco Medical Center
Jacqueline Dolev, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and California Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Maryanne Kazanis, Doris Duke Clinical Research Fellow, Clinical Unit for Research Trials in Skin, Department of Dermatology, Brigham and Women's Hospital
Maryanne Kazanis 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.

Medical Editor

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 Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting

Pharmacy Editor

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.

Managing Editor

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.

CME Editor

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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