A patient who smokes a pipe presents with a diffuse, whitish discoloration of the hard palate. Multiple small red dots (dilated and inflamed minor salivary gland duct openings) are visible throughout the lesion. What is the diagnosis?

This presentation is classic for nicotinic stomatitis (stomatitis nicotina), a benign, reactive change of the hard palate caused by heat and chemical irritants from tobacco smoke — particularly pipe and cigar smoking. The whitish diffuse keratosis of the palate with multiple red papular dots (representing inflamed minor salivary gland orifices) is pathognomonic. Unlike reverse smokers (who hold the lit end inside the mouth), regular smokers with nicotinic stomatitis have low malignant potential. The condition is typically reversible with cessation of smoking.