A Long Shadow from Childhood: Oral Leukoplakia with Epithelial Dysplasia in a 25-Year-Old with Early-Onset Tobacco Use

Abstract

Background: Oral leukoplakia is the most common potentially malignant disorder of the oral mucosa, and its risk of malignant transformation is closely linked to the presence and severity of epithelial dysplasia. Tobacco use is a major modifiable risk factor, and early-onset exposure may result in a longer cumulative carcinogenic burden. Potentially malignant oral lesions occurring at a young age are less commonly reported and warrant clinical attention. We present a case of biopsy-confirmed oral leukoplakia with epithelial dysplasia in a young adult with a history of tobacco use beginning in childhood.

Methods: A 25-year-old male presented with a persistent, non-scrapable white lesion on the lateral border of the tongue, with a reported history of tobacco use beginning at approximately 10 years of age. Clinical examination did not reveal an identifiable local mechanical or frictional cause. An incisional biopsy was performed, and the specimen was evaluated histopathologically. Based on clinical and histopathological findings, the patient was managed with a chemopreventive pharmacological regimen combined with tobacco-cessation counselling and structured clinical surveillance.

Results: Histopathological examination demonstrated hyperkeratosis with orthokeratinization, acanthosis, loss of basal-cell polarity, premature and individual-cell keratinization, nuclear hyperchromatism, cellular pleomorphism, an increased nuclear-tocytoplasmic ratio, atypical mitotic figures, and dyskeratosis, along with chronic subepithelial inflammatory infiltration and focal fibrosis findings consistent with oral leukoplakia with epithelial dysplasia. The patient was managed with oral lycopene, vitamin A (retinol), vitamin E, and topical tretinoin, alongside counselling for complete tobacco cessation and scheduled follow-up for lesion monitoring.

Conclusion: This case highlights the clinical significance of early-onset tobacco exposure and the occurrence of potentially malignant oral lesions at a young age. It underscores the importance of timely biopsy and histopathological evaluation of persistent oral white lesions, particularly when conventional local causes are absent, along with long-term surveillance given the risk of malignant transformation.