A type of smokeless tobacco, known as Maras powder, is widely used in lieu of cigarettes in the south-eastern region of Turkey. In the present study, we evaluated cytological smears obtained from the lesion of lower lip mucosa of 80 smokeless tobacco users. There were severe epithelial abnormalities in seven out of the 80 subjects. Punch biopsies from these cases disclosed dysplasia in three cases, carcinoma in situ in two, and carcinoma in the other two cases. There was mild dysplasia in two punch biopsies of the remaining 73 cases. Oral cancer in tobacco powder users appeared to be related to the length of use, as it was observed only in subjects with 15 or more years of exposure.