The Case of Stained and Wrinkled Mucosa

A student noted "wrinkling" and some staining in the buccal vestibule of an army soldier during the initial exam. I was called on a consult. The patient had no symptoms and was not aware of the presence of this lesion. The student told me that she had inquired about his tobacco status while taking history and he had told her he did not use "cigarettes". When I inquired about his smokeless tobacco status specifically, he confessed that he had been using stuff for several years.

Smokeless tobacco keratosis in a young male

The patient was reassured and a change in placement site was recommended. I was not able to see the patient on his 2-week follow-up but I was told by the student that the lesion had resolved completely.

Smokeless Tobacco Keratosis:

Smokeless tobacco keratosis is a benign mucosal alteration that develops secondary to use of snuff, snus and other forms of smokeless tobacco. It usually has a wrinkly, semi-translucent appearance. To confirm the diagnosis of smokeless tobacco keratosis and to rule out the possibility of a premalignant process, changing of placement site is recommended. If the mucosa returns to its normal appearance  2 weeks following change of placement site, the patient is reassured. If the changes persist, then a biopsy is mandatory.