mucobuccal vestibule
Clinical Presentation • Usually in men in Western countries • Powdered snuff use prevalent in Southeast United States often
by women • Mucosal pouch with soft, white, fissured appearance • Surface may be pumice-like to verrucous • Leathery surface due to chronic tobacco use over many years
Microscopic Findings • Hyperkeratosis with parakeratotic “chevron sign” at surface • Increased vascularity • Older lesions with hyalinization in submucosa and minor
salivary glands • Epithelial dysplasia and carcinoma may evolve.
Diagnosis • Clinical appearance • Biopsy
Differential Diagnosis • Leukoplakia (idiopathic) • Mucosal burn (chemical/thermal)
Treatment • Discontinuation of habit • If dysplasia is present, stripping of mucosal site
Prognosis • Generally good with tobacco cessation • Malignant transformation to squamous cell carcinoma or verru-
cous carcinoma occurs but less frequently than does smokingrelated carcinoma.