Pigmentation in Oral cavity, Slides of Oral Medicine

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PIGMENTED LESIONS OF ORAL

CAVITY

Dr Sonia Sodhi DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY



It is light pink in colour , lighter in case of keratinized

mucosa



Colour is because of

vascularity

thickness of epithelium

keratinization

pigments

Why is mucosa coloured

 To obtain an accurate diagnosis, thorough social, family, medical, and dental histories are required.  Various diagnostic procedures like diascopy, dermascopy, binocular stereoscopy, laboratory tests, radiological investigations and biopsy may be necessary. HISTORY TAKING IN PIGMENTED LESIONS

SOURCE ETIOLOGY EXAMPLES METAL Iatrogenic, medications, environment Amalgam tattoo, chrysiasis, black tongue, heavy-metal pigmentation GRAPHITE INK Trauma Graphite tattoo or injury BACTERIA Poor oral hygiene, antibiotics Hairy tongue DRUG COMPLEXES Medications Minocycline-induced pigment PLANT DERIVATIVES Factitious, tribal customs Ornamental tattoo, orange mouth EXOGENOUS PIGMENTATION

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Focal multifocal

diffuse patterns.

 (^) Overall, melanotic macules tend to be small (<1 cm), well circumscribed, oval or irregular in outline, and often uniformly pigmented.  Once the lesion reaches a certain size, it does not tend to enlarge further.  Unlike an ephelis, a melanotic macule does not become darker with continued sun exposure.  (^) Differential diagnosis  melanocytic nevus,  malignant melanoma,  amalgam tattoo, and  focal ecchymosis.

 (^) Oral melanoacanthoma is an innocuous melanocytic lesion that may spontaneously resolve, with or without surgical intervention.  (^) Rapid onset; and acute trauma or a history of chronic irritation.  Oral melanoacanthoma usually presents as a rapidly enlarging, ill- defined, darkly pigmented macular or plaque-like lesion, and mostly develop in black females. The borders are typically irregular in appearance, and the pigmentation may or may not be uniform.  (^) Although lesions may present over a wide age range, the majority occur between the third and fourth decades of life. ORAL MELANO ACANTHOMA

 Oral melanocytic nevi have no distinguishing clinical characteristics.  Lesions are usually asymptomatic and often present as a small (<1 cm), solitary, brown or blue, well-circumscribed nodule or macule.  (^) Up to 15% of oral nevi may not exhibit any evidence of clinical pigmentation.  Once the lesion reaches a given size, its growth tends to cease and may remain static indefinitely.  Oral nevi may develop at any age; however, most are identified in patients over the age of 30.  (^) The hard palate represents the most common site, followed by gingiva,the buccal and labial mucosae.

 Blue nevi are characterized by a variety of microscopic appearances.  The “common” blue nevus, which is the most frequent histologic variant seen in the oral cavity, is characterized by an intramucosal proliferation of pigment-laden, spindle-shaped melanocytes.  (^) The blue nevus is described as such because the melanocytes may reside deep in the connective tissue and the overlying blood vessels often dampen the brown coloration of melanin, which may yield a blue tint.  The less frequently occurring cellular blue nevus is characterized by a submucosal proliferation of both spindle-shaped and larger, round- or ovoid-shaped melanocytes. BLUE NEVI

 The clinical characteristics of cutaneous melanoma are best described by the ABCDE criteria:  A symmetry,  (^) Borders(irregular),  Color variegation,  Diameter greater than 6 mm and  Evolution or surface elevation.  (^) These criteria are very in differentiating cutaneous melanoma from other focally, pigmented melanocytic lesions.

 There are four main clinicopathologic subtypes of melanoma.  Superficial spreading melanoma,  Lentigo maligna melanoma,  (^) Acral lentiginous melanoma, and  (^) Nodular melanoma.  In the first three subtypes, the initial growth is characterized by radial extension of the tumor cells (radial growth phase). In this pattern, the melanocytic tumor cells spread laterally and therefore superficially. These lesions have a good prognosis if they are detected early and treated before the appearance of nodular lesions, which indicates invasion into the deeper connective tissue (i.e., a vertical growth phase).  The development of nodularity in a previously macular lesion is often an ominous sign.

 Ulceration, pain, tooth mobility or spontaneous exfoliation, root resorption, bone loss, and paresthesia/anesthesia may be evident. However, in some patients, the tumors may be completely asymptomatic.  Clinical differential diagnosis  melanocytic nevus,  oral melanotic macule,  (^) amalgam tattoo,  (^) other soft tissue neoplasms.

MULTIFOCAL/ DIFFUSE PIGMENTATION