I was a user of snuff chewing tobacco from the time I was about 14 - 24 years of age, and then cigarettes for 10 years after that, I am now 34. I used to place the tobacco behind my lower lip. My question is this, I notice for a long time after quitting chewing tobacco that the mucous membrane there never completely 'healed', but always remained somewhat inflamed, tender, and that there were many larger bumps all over my inner lower lip where I placed the tobacco. I was told that these are just salivary glands and is normal (Even though I do not remember noticing them to the same extent when I was younger). However, when I pull my lip back in a certain way, I can see many tiny raised bumps on top of these larger bumps, and the tissue just looks very different than that behind my upper lip. I tried to tell my dentist, but he did not seem to pay much attention or examine more thorougly than normal, and thought I was just becoming more aware of my mouth.
I am wondering if the tiny bumps are seen in some people normally, or could be a precursor to cancer, or cancer. I am really freaked out over this, but at the same time feel like I am just being a hypochondriac since my dentist did not say anything about it (although the dental hygenist said she could see damage in my mouth from the tobacco). Should I see a specialist about this, and if so what type?
There is clearly a link between chewing tobacco use and oral cancer, primarily squamous cell carcinoma.
The area you describe sounds like what is called "erythroplasia"
Erythroplasia is a red lesion of the oral mucosa with no apparent cause. Erythroplasia also should be carefully evaluated especially if there is history of tobacco usage. Erythroleukoplakia is a frequent combination of white and red lesions. These combined lesions have four times the potential for malignant transformation than that of a plain white or red lesion and because of this increased risk invariably they should be biopsied.
Leukoplakia is a swelling and/or inflammation of the oral mucosa in response to some irritant. It commonly presents as a white, thickened "plaque" and is typically painless. This can be a precancerous condition. It is associated with pipe smoking, use of chewing tobacco or in some cases poorly fitting dentures. The focus of treatment of this condition is to remove the irritating factor(s). Regardless of the type of leukoplakia present, one should consider consultation with an Ear Nose and Throat (ENT) specialist if this condition persists despite removal of the offending agent(s).
The fact that you have a persistent lesion is somewhat concerning. It is really difficult to say whether or not this represents a cancer without a biopsy. I don't think you are being a hypochondriac, a persistent oral lesion in a previous smoker and/or chewing tobacco user needs to be biopsied ... period.
The best course of action for you to consider is to have an Ear, Nose and Throat doctor (ENT) examine the area in question and to have a biopsy taken.
I hope all turns out well for you.
Dean M. Tomasello, M.D.
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