Pathology · patient case question
What is the appropriate management of this palatal lesion?
Patient case: Palatal changes beneath a maxillary denture in a tobacco user
Patient: Male, 63 years old
Chief Complaint: Routine review of a maxillary complete denture worn for eight years.
Background: Long-standing pipe and cigarette smoker. Wears the denture day and night.
Current Findings: The hard palate is erythematous with a keratotic, leukoplakic background. Numerous small elevated red papules with punctate central openings — inflamed minor salivary gland duct orifices — are visible across the palatal mucosa.
Show answer and explanation
Correct answer: D. Tobacco cessation, with reassessment and biopsy of any lesion that persists
- A. Excision is not indicated for a reversible keratosis. Surgery follows a biopsy diagnosis of dysplasia or malignancy, not the clinical appearance alone.
- B. Nystatin is an antifungal and treats DENTURE STOMATITIS. Nicotinic stomatitis is a keratotic response to heat, with no fungal component, and will not respond.
- C. Denture adjustment does not address the aetiology, and a one-year review is too long a delay for a keratotic palatal lesion in a heavy smoker.
- D. CORRECT. Nicotinic stomatitis in a conventional smoker is REVERSIBLE — the palate typically returns to normal within a few weeks of stopping. Cessation is therefore both the treatment and the diagnostic test. Anything that persists after cessation, or that develops induration or ulceration, must be biopsied.
Note: ⚑ SOURCE CORRECTION — this is worth circulating to the group. The recall keys the treatment of nicotinic stomatitis as NYSTATIN. That is wrong; nystatin belongs to the denture stomatitis item. Two further points make this more than a technicality: in a REVERSE smoker (lit end inside the mouth) nicotinic stomatitis DOES carry real malignant potential and needs biopsy, and beneath a denture the palate is shielded from heat, so keratosis appearing there is more suspicious rather than less.