To elucidate whether betel-associated oral squamous cell carcinoma is associated with p53 protein expression, tumor samples from 156 patients with detailed histories of exposures were investigated immunohistochemically using CM1 antibody. The expression of p53 (>10% positive cells) was found in 38.5% of the cases. The frequency of expression in betel chewers alone and betel chewer with tobacco use were 37.9% (11/29) and 25%(9/36), respectively, whereas that in betel chewers with smoking/drinking it was 47.2%(17/36) and in smokers or drinkers without chewing was 42.0% (21/50). However, the differences were not statistically significant. Multivariate analysis also revealed with the no independent association of betel chewing with p53 expression (odds ratio [OR] 1.81, 95% confidence interval 0.50-6.49), whereas alcohol drinking and smokeless tobacco use were significant (OR 7.58, 2.01-28.53 and 0.39, 0.16-0.98, respectively). These results suggested that betel chewing with or without smokeless tobacco use may not induce oral cancers via a p53-dependent pathway. However, since this is an immunohistochemical study, further molecular analysis is needed.