
























































Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
Community
Ask the community for help and clear up your study doubts
Discover the best universities in your country according to Docsity users
Free resources
Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors
Pigmentation in Oral cavity- Exogenous and Endogenous causes
Typology: Slides
1 / 64
This page cannot be seen from the preview
Don't miss anything!
Dr Sonia Sodhi DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY
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
(^) 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