Snuff lesion (smokeless tobacco lesion)
DESCRIPTION: The lesion develops on the mucosa where smokeless tobacco is held. The usual appearance is white, wrinkled or corrugated mucosa. Gingival recession is a common manifestation with cervical erosion of teeth a less frequent finding. Symptoms are uncommon.
ETIOLOGY: Prolonged use of smokeless tobacco produces such as chewing tobacco or snuff.
TREATMENT: Biopsy should be done to rule out dysplasia, otherwise no treatment is necessary.
PROGNOSIS: Verrucous and squamous carcinomas arise in smokeless tobacco lesions more than chance alone can explain. One article noted almost a 50-fold increased risk of cancers of the gingival and buccal mucosa in females who were chronic users. The duration necessary to induce dysplastic or malignant change is unknown but appears to be at least 20 years.
DIFFERENTIAL DIAGNOSIS: The clinical appearance of the lesion plus a history of using smokeless tobacco establishes the diagnosis.
