Etiology • Results from direct mucosal contact with a quid containing areca (betel) nut, tobacco, and other ingredients; alkaloids and tannin in the areca nut are liberated by action of slaked lime within the quid, which is wrapped with the betel leaf • Risk of oral squamous cell carcinoma is increased several-fold Clinical Presentation
• Early phase: tenderness, vesicles, erythema, burning, melanosis • Later phase: mucosal rigidity, trismus • Sites most often affected: buccal mucosa, soft palate • Leukoplakia of surface with pallor • Deep scarring, epithelial atrophy in cheeks, soft palate Microscopic Findings • Biopsy results show submucosal deposition of dense collagen. • Epithelial thinning, hyperkeratosis • Epithelial dysplasia found in up to 15% of cases Diagnosis • Appearance • History Differential Diagnosis • Lichen sclerosus Treatment • Intralesional corticosteroid placement • Surgical release of scar bands in latter stages • Careful follow-up and vigilance for development of squamous cell carcinoma Prognosis • Irreversible • Fair