Tobacco –Related Lesions
Oral Medicine Block
Nicholas Quach
Sean Young
Sanaz Hamzehpour
Smoker’s Melanosis
• Background
– Constituent of tobacco smoke stimulates
increased melanin production.
– Common in men & women
• More intense in female smokers who also take
conraceptive pills.
Smoker’s Melanosis
• Clinical features
– Location:
• Most commonly on Max & Mand anterior labial
gingiva
• Other sites: buccal mucosa, FOM, soft palate
Smoker’s Melanosis
• Histopathology
– Features are similar to those found in a
melanotic macule.
– Increased melanin deposits are found within
basal epithelial cells.
– Underlying CT exhibits a mild infiltrate of
lymphocytes.
Smoker’s Melanosis
• Treatment
– Cessation of smoking.
– Pigmentation goes away within a few months.
– If pigmentation persists, biopsy the lesion.
Snuff Dipper’s Lesion/Pouch
• Background
– Keratotic changes in response to chronic
smokeless tobacco use.
– Different from leukoplakia.
Snuff Dipper’s Lesion/Pouch
• Clinical features
– Localized in areas with direct contact with
smokeless tobacco.
– Fissured, poorly demarcated, & soft velvety
feel
Snuff Dipper’s Lesion/Pouch
• Histopathology
– Squamous epithelium is hyperplastic and
hyperkeratinized.
– Intracellular edema of superficial layers which
results in a translucent/edematous clinical
appearance.
• Treatment
– Biopsy may be indicated to rule out cancer.
– Cessation of use of smokeless tobacco.
Nicotinic Stomatitis
• Background
– Palatal lesion seen in smokers.
– Concentrated heat from burning of the
tobacco produces the lesion.
– Most often observed in pipe and reverse
cigarette smokers.
Nicotinic Stomatitis
• Clinical features
– Usually lesions are in the posterior hard
palate and adjacent soft palate.
– Reddened area that changes to a thickened,
white appearance & wollen minor salivary
gland orifices become dilated and are seen as
speckled red dots.
Nicotinic Stomatitis
• Histopathology
– Lesions are acanthotic and hyperkeratotic.
– Mild to moderate chronic inflammation.
– Epithelium of minor salivary gland ducts may
shouw aquamous metaplasia.
• Treatment
– Smoking cessation.
Black Hairy Tongue
• Background
– Desquamation of filiform papillae resulting
from various factors.
Black Hairy Tongue
• Clinical features
– Black dorsum of tongue.
– Hairy tongue can be black due to tobacco
smoke, but can be other colors depending
upon precipitating factors.
Black Hairy Tongue
• Histopathology
– Hypertrophy and elongation of filiform
papillae, which can be as long as 15 mm.
• Treatment
– OHI
– Determination of cause, ie: tobacco smoking.
– Smoking cessation.
Submucous Fibrosis
• Background
– Usually involves the chewing of betel quid,
which also contains tobacco.
Submucous Fibrosis
• Clinical features
– Stiffening of mucosa typically affects the
buccal mucosa, lips, retromolar pads.
– As the disease progresses, it may involve the
tongue and cause it to be stiff.
Submucous Fibrosis
• Histopathology
– Chronic inflammatory cell infiltration of
subepithelial CT.
– Nonspecific infiltration of eosinophils.
– Reduced vascularity of tissues is possible.
Submucous Fibrosis
• Treatment
– This condition is irreversible once formed.
– No effective treatment.
– Surgery may be indicated to improve oral
conditions.
Squamous Cell Carcinoma
• Pathogenesis:
– A malignant neoplasm of the stratified
squamous epithelium that starts as epithelial
dysplasia and ends as the dysplastic epithelial
cells invade the basement membrane thus
invading connective tissue.
Squamous Cell Carcinoma
• Clinical features
– Most common clinical oral presentation are
leukoplakias and erythroplakias. Advanced
lesions first appear as painless ulcers,
tumorous mass or verrucous (papillary)
growth.
– Horse-shoe oral areas are more prone to
SCC, which consist of the anterior floor of the
mouth, lateral border of the tongue, tonsillar
pillars and lateral soft palate.
Squamous Cell Carcinoma
• Clinical features
Squamous Cell Carcinoma
• Diagnostic tests
– SCC is diagnosed by microscopic
examination of a representative biopsy of the
neoplastic tissue.
Squamous Cell Carcinoma
• Histologic appearance:
– 3 stages:
• Well-differentiated SCC: Microscopic features reveal
irregularly elongated rete pegs invading the connective tissue
and the presence of keratin pearls. Eg. SCC of the lower lip.
• Moderately-differentiated SCC: exhibits an abrupt line of
demarcation between the normal epithelium and invasive
neoplastic epithelium that is non-keratinized and exhibits loss
of cellular cohesiveness. Eg. SCC of the lateral borders of
the tongue.
• Poorly-diffentiated SCC: exhibits sever cellular abnormalities
and hyperchromatism and pleomorphism. Eg. SCC of
tonsillar beds.
Squamous Cell Carcinoma
• Histopathology
Squamous Cell Carcinoma
• Treatment
– SCC is usually treated by surgical excision or
radiation therapy or both.
Test Question 1
• Which of the following features of smoker’s
melanosis is NOT correct?
– A. Smoker’s melanosis is benign and should
therefore not be biopsied.
– B. Pigmentation from smoker’s melanosis resolves
itself after patient stops smoking.
– C. Smoker’s melanosis is found most commonly on
the labial mucosa
– D. If patient is taking contraceptives, pigmentation
from smoker’s melanosis is more intense
Test Question 2
• Which of the following is NOT one of the
clinical manifistations of SCC?
– A. Tumorous mass
– B. Papillary growth
– C. Leukoplakias
– D. Melanoma