Palatal keratosis associated with reverse (or "backwards") smoking (PKARS)

Palatal mucosal changes secondary to smoking habit have been recognised since at least the 19th century. Smoker's palate, or nicotinic stomatitis is associated with habitual cigar or pipe smoking, regular consumption of thermally hot beverages and more recently has been identified in those who vape. It is considered of negligible malignant transformation risk, typically resolving on habit cessation. However a variant, palatal keratosis associated with reverse smoking (PKARs), is recognised as an established oral potentially malignant disorder. Reverse smoking involves smoking the lit end of the cigarette intraorally and the condition may result in increased incidence of palatal squamous cell carcinoma development. We highlight a case to create awareness of both this unusual smoking habit, and the palate as an overlooked site in oral cancer screening.