Clinical Findings

In February 2007 (Figure 1), the patient presented with diffuse thick white to yellow plaques on the anterior and middle hard palate.  Some of the thick plaques were present over her prominent torus palatinus (Figure 1).   The middle hard palate and the maxillary alveolar ridge showed multiple brown macules (figures 1 & 2) which are interpreted to be consistent with smoker’s melanosis but can also be combined racial pigmentation and smoker’s melanosis.  There was no evidence of ulceration or erythematous changes.  On her second visit (August 2007, after six months of tobacco cessation), most of the thick plaques had disappeared and only two small oval to round thin white plaques were present over the torus palatinus (Figure 2).  The two plaques were completely excised and submitted for microscopic evaluation. 

Figure 1.  This photograph was taken in February 2007.  Note the thick and diffuse, white to yellow plaques on the middle and anterior hard palate, some overlying the torus palatinus

Figure 2. This photograph was taken in August 2007 after six months of cessation of reverse smoking.  Note only two small flat white plaques are present overlying the torus palatinus.