Oral Pathology: Soft Tissue Case #4
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Patient: Teenage male
Patient requests a routine examination.
No abnormalities are identified. The patient has a history of using smokeless tobacco.
No abnormalities are identified.
A white plaque approximately 1 cm in diameter is located in the left maxillary mucolabial fold. The lesion is slightly thickened, nontender, firm and rough. It is fixed to the surface mucosa but not to the underlying structures. The patient has been aware of the lesion for six or seven months.
There are no radiographs available for this case.
There are no lab reports available for this case.
There are no charts available for this case.
This is a white surface lesion. It is white due to epithelial thickening because it is rough, asymptomatic, and will not rub off.
Lesions to Exclude from Differential Diagonsis:
~Location – Bilateral buccal mucosa
~Location – Hard Palate
Familial Epithelial Hyperplasia (White Sponge Nevus)
~Diffuse and multifocal
~Present from early childhood
~May have a familial history.
Hairy Tongue, Geographic Tongue (Erythema Migrans), and Hairy Leukoplakia
~Location – Tongue
Lesions to Include in Differential Diagnosis:
Hyperkeratosis – also known as Smokeless Tobacco Keratosis
~From use of smokeless tobacco
Epithelial dysplasia, Carcinoma-in-situ, and Squamous Cell Carcinoma
~Unlikely because the lesion has a homogeneous appearance without nodular thickenings. Smokeless tobacco lesions with a homogeneous surface are almost always diagnosed as hyperkeratosis microscopically.
Patient Education: Smokeless tobacco keratosis appears to have a low potential for malignant transformation. The systemic cardiovascular effects of smokeless tobacco and the common periodontal attachment loss associated with smokeless tobacco use should also be explained.
Performing an incisional biopsy might motivate the patient to discontinue the habit as well as provide a definitive diagnosis.
Smokeless Tobacco Keratosis