Smokeless Tobacco Lesions Workup

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

Laboratory Studies

No blood tests are available to help diagnose cancers of the oral cavity.

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Imaging Studies

Typically, imaging studies are reserved for staging purposes once oral cancer has been diagnosed. Chest radiography, barium swallow, MRI, and positron emission tomography scanning may be used to rule out the involvement of other organ systems.

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Other Tests

A thorough history, including an assessment of the risk factors, and a careful examination of the oral cavity are the most important clinical tools in diagnosing oral lesions. The physical examination must include an assessment of the cervical lymph nodes.

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Procedures

In order to better visualize lesions of the throat, base of the tongue, and larynx, indirect pharyngoscopy and laryngoscopy may be performed. In addition, if suspicion for a head or neck cancer is strong, endoscopy may be performed to more thoroughly examine the oral cavity, oropharynx, larynx, esophagus, trachea, and bronchi.

Exfoliative cytology of a suggestive lesion may be performed, but oral cancer can only be definitively diagnosed based on findings from an incisional biopsy.

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Histologic Findings

Tobacco-associated keratosis appears as epidermal thickening or hyperkeratosis and acanthosis. Dysplasia is uncommon in this lesion.

Leukoplakia appears as hyperkeratosis due to chronic irritation in approximately 80% of cases. A minority of lesions shows precancerous changes with varying degrees of dysplasia.

Speckled leukoplakia exhibits both epithelial hyperplasia and epithelial atrophy. Dysplasia occurs in 50-70% of all lesions, but carcinoma is rarely diagnosed. Candidal infection may be a common finding, with an inflammatory infiltrate of lymphocytes and plasma cells in the underlying connective tissue. The role of candidal species in causation of the lesion is unclear.

Erythroplasia shows mild-to-moderate epithelial dysplasia in only 9% of lesions obtained from biopsy samples. Severe dysplasia, carcinoma in situ (CIS), or squamous cell carcinoma (SCC) is often apparent. The clinical size of the lesion is not correlated with microscopic severity.

CIS refers to severe dysplasia extending the full thickness of the epithelium. Grossly, CIS may appear as leukoplakia, speckled leukoplakia, erythroplasia, or keratosis.

At histologic examination, SCC shows increased cellular proliferation, atypical mitotic figures, loss of cell cohesion, and/or atypical keratinization. Invasive growth is indicated by the invasion of tumor cells into the epithelial basement membrane. Verrucous carcinoma is a specific form of SCC that exhibits a high level of differentiation.

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Staging

See the American Cancer Society detailed guide on oral cavity and oropharyngeal cancer: " How Are Oral Cavity and Oropharyngeal Cancers Staged."

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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

  1. 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].

  2. Warnakulasuriya KA, Ralhan R. Clinical, pathological, cellular and molecular lesions caused by oral smokeless tobacco--a review. J Oral Pathol Med. Feb 2007;36(2):63-77. [Medline].

  3. [Best Evidence] Luo J, Ye W, Zendehdel K, 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].

  4. Hassan MM, Abbruzzese JL, Bondy ML, 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]. [Full Text].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

  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. 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].

  13. Cogliano V, Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F. Smokeless tobacco and tobacco-related nitrosamines. Lancet Oncol. Dec 2004;5(12):708. [Medline].

  14. Gray N, Hecht SS. Smokeless tobacco--proposals for regulation. Lancet. May 8 2010;375(9726):1589-91. [Medline].

  15. Smokeless tobacco report for the year 2006. Washington, D.C.: Federal Trade Commission; 2009.

  16. Tomar SL, Alpert HR, Connolly GN. Patterns of dual use of cigarettes and smokeless tobacco among US males: findings from national surveys. Tob Control. Apr 2010;19(2):104-9. [Medline].

  17. McClave AK, Whitney N, Thorne SL, Mariolis P, Dube SR, Engstrom M. Adult tobacco survey - 19 States, 2003-2007. MMWR Surveill Summ. Apr 16 2010;59(3):1-75. [Medline].

  18. McClellan SF, Olde BA, Freeman DH, Mann WF, Rotruck JR. Smokeless tobacco use among military flight personnel: a survey of 543 aviators. Aviat Space Environ Med. Jun 2010;81(6):575-80. [Medline].

  19. Global Data on Incidence of Oral Cancer. World Health Organization - Oral Health. Available at http://www.who.int/oral_health/publications/cancer_maps/en/. Accessed June 28, 2010.

  20. 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].

  21. 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]. [Full Text].

  22. Oral Cancer Incidence (New Cases) by Age, Race, and Gender. National Institute of Dental and Craniofacial Research; March 20, 2010. [Full Text].

  23. Ebbert JO, Edmonds A, Luo X, Jensen J, Hatsukami DK. Smokeless tobacco reduction with the nicotine lozenge and behavioral intervention. Nicotine Tob Res. Aug 2010;12(8):823-7. [Medline]. [Full Text].

  24. 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].

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

  26. Dale LC, Ebbert JO, Hays JT, Hurt RD. Treatment of nicotine dependence. Mayo Clin Proc. Dec 2000;75(12):1311-6. [Medline].

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

  28. Aggarwal A, Jain M, Jiloha RC. Varenicline for smokeless tobacco dependence. J Postgrad Med. Jan-Mar 2010;56(1):50. [Medline].

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

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

 
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Verrucous carcinoma.
Oral leukoplakia.
 
 
 
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