History of the present illness
This is a 46-year-old male who presented with a lesion on the right buccal mucosa, from the linea alba through the buccal vestibule to the area of teeth #s 30 and 31.  The buccal mucosa appeared white and wrinkled from the mesial of tooth #29 to the distal of tooth #31 (Figure 1A).  The lesion was first noticed by the patient’s general dentist in 1999, at which time it was white, wrinkled, soft, non-fixed and non-tender.  At both presentations, there were no palpable masses, and head and neck examination was otherwise within normal limits.  The patient has an extensive history of tobacco and alcohol use; he has been using tobacco for 20 years and drinks different kinds of alcohols. The lesion has remained relatively unchanged, except for a brief period last winter; it began to improve when the patient stopped using tobacco for two weeks from 12/28/04 to 01/10/05 (Figure 1B).  He also developed a similar lesion on the left buccal mucosa as a result of switching tobacco use from right to left (Figure 1C).