There are multiple factors associated with the development of oral cancer, but nearly all oral epithelial cancers are associated with the use of tobacco or alcohol abuse. The relative risk of oral cancer is 1 if fewer than 10 cigarettes are smoked daily and minimal alcohol is consumed. However, then more than 40 cigarettes are smoked daily and more than 10 whisky equivalents are consumed, the relative risk of oral cancer rises to greater than 100. One whiskey equivalent equals 1.5 ounces of 86 proof whiskey, 12 ounces of beer, or 4 ounces of wine. Smokeless tobacco, like cigarettes, contains nitrosamines and is as addictive as cigarettes. Oral lesions associated with dipping snuff are most commonly homogenous, but may have nodular areas. Such lesions occur most commonly on the buccal mucosa and vestibule, where the snuff is placed. These lesions may exhibit malignant changes, therefore biopsy should be performed in the presence of suspicious clinical signs such as a mass or regional adenopathy in the neck.
(Source: AAOMS Surgical Update, Vol. 18, Issue 1, 2003)