A 39-year-old man was concerned that his history of long-term
nicotine exposure placed him at increased risk for
throat cancer. He had used about 2 cans of "dip" each week
for many years. The patient habitually placed the tobacco
in the right lower lip area; to avoid spitting, he always swallowed
the spent wad. The patient did not smoke; he used
Lesions on the buccal mucosa were noted during the
examination; a full nasolaryngoscopy was performed.
Chronic cryptic adenitis also was found, and the patient
was referred to an ear, nose, and throat specialist.
The mucosal lesions were diagnosed as focal leukoplakia
and hyperkeratosis--both of which are precancerous
lesions. Because there was no evidence of malignancy,
a biopsy was not performed. The patient was counseled to
stop the use of tobacco and to return for frequent follow-up
examinations. Sustained-release bupropion, 150 mg bid,
Squamous cell carcinoma develops in up to 17% of patients
with leukoplakia; another 24% have some form of dysplasia.
Many of these lesions spontaneously involute when
tobacco use ceases.1
(Case and photograph courtesy of Dr Kenneth LeCroy.)