Oral Pathology:  Soft Tissue Case #4


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Patient: Teenage male

Chief Complaint:
Patient requests a routine examination.

Medical History:
No abnormalities are identified. The patient has a history of using smokeless tobacco.

Dental History:
No abnormalities are identified.

Clinical Findings:
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.

Left Maxillary Mucolabial Fold with White Lesion
left maxillary mucolabial fold with white lesion


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

Lichen Planus

Nicotinic Stomatitis
  ~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.

Final Diagnosis:
Smokeless Tobacco Keratosis