Clinical and Histopathological Profile of Tobacco-Associated Oral Mucosal Lesions: A Cross-Sectional Observational Study

Abstract

Background: Tobacco use is a major preventable risk factor for oral mucosal diseases and is strongly associated with the development of oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC). The present study aimed to evaluate the clinicopathological spectrum of tobacco-associated oral mucosal lesions and correlate the pattern of tobacco use with histopathological findings in a tertiary care dental hospital.

Methods: A prospective cross-sectional study was conducted at the Department of Oral & Maxillofacial Pathology and Oral Microbiology, Santosh Dental College and Hospital, Ghaziabad, from June 2024 to June 2025. A total of 2,850 patients were screened, of whom 658 were tobacco users. One hundred and forty eligible tobacco users with clinically identifiable oral mucosal lesions were enrolled. Comprehensive clinical examination was performed, and all 160 lesions underwent incisional biopsy followed by histopathological evaluation using hematoxylin and eosin staining. Epithelial dysplasia was graded according to the World Health Organization (WHO) criteria.

Results: Of the 140 participants, 119 (85%) were males and 21 (15%) were females. Smoking was the predominant tobacco habit (62.1%), with cigarette smoking being the most common form (33.5%), followed by beedi smoking (27.1%). Smoker's melanosis (25.6%) and leukoplakia (23.1%) were the most frequently diagnosed lesions, followed by oral submucous fibrosis (OSMF) (10.0%). Histopathological examination of 160 lesions revealed no dysplasia in 75 (46.9%) lesions, mild dysplasia in 45 (28.1%), moderate dysplasia in 26 (16.2%), and severe dysplasia in 14 (8.8%). Four cases (2.5%) of OSCC identified, comprising two well-differentiated, one moderately differentiated, and one poorly differentiated carcinoma. Erythroplakia and speckled leukoplakia demonstrated the highest frequency of moderate-to-severe epithelial dysplasia.

Conclusion: Tobacco use is associated with a wide spectrum of oral mucosal lesions, including lesions with significant malignant potential. Histopathological evaluation remains indispensable for identifying epithelial dysplasia and guiding early intervention. Regular oral screening of tobacco users, prompt biopsy of suspicious lesions, and effective tobacco cessation strategies are essential to reduce the burden of oral cancer.