Smokeless Tobacco Lesions Treatment & Management

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

Medical Care

To reduce the risk of progression to oral cancer, smokeless tobacco use should be minimized, with cessation encouraged. The National Cancer Institute recommends that clinicians use the "4 A s," as follows:

  • Ask about tobacco use
  • Advise patients to quit smoking
  • Assist patients in quitting
  • Arrange follow-up

Both the nicotine patch (in variable doses) and bupropion are helpful in treating nicotine dependence, with an additive effect when used in combination. Other medications useful in treating nicotine dependence include nicotine nasal spray inhalers; nicotine gum; and nontobacco snuff products containing mint, clover, alfalfa, and flavorings.

A 2010 study comparing the effectiveness of a 4-mg nicotine lozenge with behavior intervention compared with behavioral intervention alone reported no difference between groups for increasing tobacco abstinence, quit attempts, and duration of abstinence.[23]

In 2000, Horn and colleagues[24] reported that West Virginian athletes were particularly vulnerable to smokeless tobacco use. The study concluded that both middle and high school coaches were willing to help athletes quit and should act as smokeless tobacco intervention agents.

The National Spit Tobacco Education Program (NSTEP)[25] is a national organization committed to minimizing the risk of oral cancers associated with smokeless tobacco through education. This organization does not advocate smokeless tobacco use as a healthier alternative to cigarette smoking. NSTEP targets education to the general public and specifically to baseball players and their families, in whom the use of smokeless tobacco is extremely high. In fact, NSTEP is supported and endorsed by both Major League Baseball and Little League Baseball.

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Surgical Care

Biopsy should be performed on lesions of erythroplasia that are suggestive of cancer based on their appearance or location in the oral cavity or those that have failed to resolve within 2-3 weeks. Premalignant lesions and carcinoma in situ (CIS) may be permanently cured after excision or biopsy. Primary and invasive squamous cell carcinomas (SCCs) are treated with varying combinations of surgery and/or radiation.

Once a diagnosis of oral cancer is established, the therapeutic approach is multidisciplinary.

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Consultations

Treatment for oral cancer may involve consultation with the following:

  • Maxillofacial surgeon
  • Speech therapist
  • Dentist
  • Radiation oncologist
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Diet

A poor diet has been related to the development of oral cancer, but the substances in healthy foods responsible for this difference remain unclear.

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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.

References

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Oral leukoplakia.
 
 
 
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