Smokeless Tobacco Keratosis

dok_zlo — 20.10.2024

A 55-year-old man with a 40-year history of smokeless tobacco use was referred to the oral medicine clinic for evaluation of a white patch on his left inner lip. The patch was asymptomatic and had been present for years at the site at which he placed moist snuff tobacco. On physical examination, a velvety, fissured patch of mucosa was present on the inner aspect of the left lip, with a small ulcer at the center (asterisk). When stretched, this area of labial mucosa formed a pouch (outlined by white arrows). Brown discoloration of the teeth and gingival recession bordered by leukoplakia (black arrows) were also noted. A diagnosis of smokeless tobacco keratosis — also known as tobacco pouch keratosis — was made. Smokeless tobacco keratosis occurs when a thickened layer of keratin develops at the site of tobacco contact. The lesion may be associated with an increased risk of oral cancer, so referral for an incisional biopsy is warranted. Counseling regarding oral care and tobacco cessation were provided to this patient, and a referral to an oral surgeon for a biopsy was made. Unfortunately, the patient was lost to follow-up.
Author: Joseph Katz, D.M.D.
Published October 12, 2024
N Engl J Med 2024;391: e32
DOI: 10.1056/NEJMicm2405492
VOL. 391 NO. 15

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