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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 alcohol occasionally. 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, was prescribed. 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.)

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