Lesion on the hard palate
Our patient came in seeking relief from upper respiratory symptoms, but left with a referral to an oral surgeon.
Our approach to the Dx differed from the norm
Typically, you’ll make the diagnosis of nicotine stomatitis clinically, since few lesions resemble its appearance.1 The atypical nature of our patient’s lesion, however, is what prompted a biopsy. You may also do a biopsy if there is any suspicion of cancer or if a lesion is still present after the patient stops smoking.
In our patient’s case, the pathology report revealed a thickened epithelial layer with no evidence of atypia or dysplasia. The minor salivary glands showed chronic inflammatory cells consistent with nicotine stomatitis. The area biopsied also contained a large amount of hyphae, consistent with candidiasis.
Treatment hinges on smoking cessation
Primary treatment for nicotine stomatitis is for the patient to stop smoking. Most lesions will resolve within several months of smoking cessation.1 The lesion is indicative of heavy tobacco use and other mucosal tissues of the oralpharyngeal tract may have similar damage. Therefore, the oropharyngeal cavity should be thoroughly evaluated for dysplastic or malignant lesions.
Our patient received counseling on tobacco cessation and oral hygiene practices. He also received clotrimazole troches for the Candida infection. Two weeks after he started taking the anti-fungal medication, and after he began smoking cessation efforts, the lesion significantly improved. The patient did not return for additional follow-up visits, so we do not know whether the lesion resolved completely.
Correspondence
Denise Rizzolo, PA-C, MS, 348 East Main street, First Floor, Somerville, NJ 08876; rizzoloden@aol.com
