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Stage Four: Pre-Cancerous Lesions DNA mutations result in the appearance of visible lesions in the mouth's lining: Leukoplakia: White spots that cannot be removed Erythroplakia: Red patches (high risk for developing cancer) Oral Submucous Fibrosis (OSMF): Increasing stiffness of the mouth with difficulty opening Step 5: Cancerous Change After years of repeated exposure, genetic changes result in cancer that will then grow and spread into adjacent tissues until ultimately reaching the lymph nodes in the neck and even other organs