Smokeless Tobacco Lesions Differential Diagnoses

Updated: Jun 25, 2018
  • Author: Carol E Cheng, MD; Chief Editor: William D James, MD  more...
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Diagnostic Considerations

Also consider the following:

  • Chronic hyperplastic candidiasis
  • Focal frictional hyperkeratosis
  • Idiopathic leukoplakia
  • Leukoedema
  • Traumatic ulceration
  • White hairy tongue
  • White sponge nevus

Keratoacanthoma is a benign epithelial proliferation from unknown causes. Keratoacanthoma is usually found on the vermilion border, but it may also occur on the oral mucosa. It appears as a firm, white nodule with a roughened central region. It grows rapidly and then stabilizes or regresses in size. Histologically, keratoacanthoma appears as epithelial thickening with a central plug, without evidence of atypia.

Nicotinic stomatitis is a diffuse, rough, white thickening with erythematous papules on the hard palate caused by exposure to heat from smoke or burning tobacco. The lesions may also present as umbilicated nodules with central red spots. The erythematous papules or red spots are caused by irritation to the openings of the minor salivary glands. Stomatitis is asymptomatic, benign, and typically found in middle-aged and elderly men. When biopsy samples are obtained, the epithelium shows reactive hyperplasia with ductal squamous metaplasia and chronic inflammation.

Differential Diagnoses