Atypical carcinoma detected after regression of a "benign" oral white lesion. A case report.

Background: Unlike leukoplakia, the smokers' lesion - a type of oral white lesion spontaneously regressing following cessation of smoking - is generally considered a non-serious condition and there is no recommendation for subsequent follow-up of such patients.

Case Report: Here, however, we present the case of a patient (female, 56, smoker) in whom we detected a smoker's lesion which regressed completely, without any signs of abnormality or malignity. The only shadow of a doubt that led us to inviting her for another examination was an additional examination using a VELscope® autofluorescence device that revealed autofluorescence suppression on the site of the former lesion. Another examination one month later revealed a patch of epithelium with a normal color but a negligibly different light reflection in the center of the former lesion; VELscope® indicated the questionable area to still be suspect. Following excision using margins indicated by VELscope® (+2-3 mm), histopathology revealed a squamous cell carcinoma. The secondary excision was carcinoma free and even after 5 years, the carcinoma has not recurred.

Conclusion: We would like to point out that apparent spontaneous regressions of oral white lesions following smoking cessation still need attention and close follow-up to make sure that a developing squamous cell carcinoma cannot pass undetected.