One hundred eight patients with a histologically confirmed diagnosis of epithelial dysplasia of the oral cavity and a prior history of smokeless tobacco (ST) usage were identified. The mean age at time of diagnosis for female patients was almost a decade later than for male patients (63.6 versus 51.2 years). In addition, women were more likely (P = 0.02) to have moderate or severe epithelial dysplasia than men. The two most common locations (buccal mucosa/vestibule and alveolar ridge/gingiva) accounted for 82.4% of all cases. In the 44 cases which specified both ST placement and biopsy site, 90.9% demonstrated epithelial dysplasia at the location used by the patient for holding the ST. When evaluating the histologic severity of epithelial dysplasia, a trend (P = 0.02) toward focal mild or mild was noted among ST users as compared to nonusers. No difference was found in the histologic grade of the lesions associated with either snuff or chewing tobacco.