Oral Pigmentation - Cause And Gen Info

Front 1

Exogenous Pigmentation

Back 1

Types:
- Tattoos
- Heavy metals (lead, silver, and bismuth).
- Drug-related pigmentation (antimalarials, minocycline, estrogen, laxatives, tranquilizers, AIDS-related meds, others)l

Front 2

Physiologic (racial) Pigmentation

Back 2

Seen in dark-skinned individuals.
- Increased activity of melanocytes (but normal numbers of melanocytes).
- Pigmentation is symmetric and most frequently affects the gingival tissue.

Front 3

Smoker's Melanosis

Back 3

Increased melanin pigmentation in smokers.
- Melanin may exert a protective effect.
- Most frequently affects the anterior facial gingiva of cigarette smokers.
- Will gradually disappear after smoking cessation.

Front 4

Melasma

Back 4

Symmetric hyperpigmentation of sun-exposed skin associated with pregnancy or oral contraceptives.
- Dark-skinned individuals are more prone to melasma.
- May worsen over time.

Front 5

Ephelis (Freckle)

Back 5

Common, small, cutaneous light-brown macule(s) most frequently seen on the face, arms, and back of fair-skinned individuals.
- Focal area of increased melanin production, but normal numbers of melanocytes.
- First appear in childhood and adolescence and become less prominent with time.
- More prominent after sun exposure.

Front 6

Actinic Lentigo
(Solar Lentigo, Age Spots, Liver Spots)

Back 6

Benign, well-demarcated but irregular, brown macule(s) which occur as a result of chronic UV damage.
- Very common in elderly whites (90% of whites over 70).
- Commonly seen on dorsal hands, face and arms.
- The lesions do not change with sun exposure.

Front 7

Lentigo Simplex

Back 7

Small, solitary, brown-black, uniformly pigmented, sharply circumscribed macule.
- May represent an early melanocytic nevus.
- Does not change with sun exposure.
- If multipe, consider a syndrome (LEOPARD, Peutz-Jegher's)

Front 8

Oral Melanotic Macule

Back 8

Solitary, well demarcated, uniformly pigmented, brown macule on lip, buccal mucosa, gingiva or palate.
-Some lesions may appear blue or black.
-Labial melanotic macule may be associated with sun exposure.

Front 9

Oral Melanoacanthoma

Back 9

Benign, darkly pigmented, flat (or slightly raised) lesion of the buccal mucosa which is thought to be reactive.
- Often exhibits initial rapid growth and may reach several centimeters in size.

Front 10

Acquired Melanocytic Nevus (Mole)

Back 10

Benign proliferation of necus cells: Junctional, compound, and intramucosal subtypes.
- Oral: Most are located on the gingiva or the palate; similar to skin nevi, but usually not papillary.

Front 11

Blue Nevus

Back 11

Blue macule or dome-shaped lesion caused by a benign proliferation of spindle-shaped melanocytes deep within the connective tissue.
- Color is due to the Tyndall effect.
- 2nd most common nevus seen in the mouth.
- Oral lesions are almost always located on the palate.

Front 12

Melanoma

Back 12

Malignant tumor of melanocytes.
- Oral melanomas begin as brown to black macule with irregular borders which may become exophytic and nodular. 20% are barely pigmented.
- Acral lentiginous subtype is the most common type seen intraorally.
- Prognosis for oral melanoma is extremely poor (20% 5-yr survival rate).

Front 13

Peutz-Jeghers Syndrome
(p. 653-654)

Back 13

Uncommon syndrome characterized by dark, freckle-like lesions of the extremities and periorificial areas and intestinal polyposis.
- Inherited or sporadic.
- "Freckles" do not wax and wane with sun exposure.
- Intestinal polyps are benign, although patients do have an increased risk of adenocarcinoma (develops in 2-3%).
- Intussusception is common.
- 18x greater frequency of tumors in various organs (pancreas, GU, breast, ovary).

Front 14

McCune-Albright Syndrome
(p. 555-556)

Back 14

Polyostotic fibrous dysplasia, café-au-lait pigmentations, and multiple endocrinopathies.
- The pigmented lesions have irregular borders (coastline of Maine).
- Oral pigmented macules may also be present.

Front 15

Addison's Disease (Hypoadrenocorticism)
(p. 727-728)

Back 15

Insufficient production of adrenal corticosteroids due to destruction of the adrenal cortex (primary hypoadrenocoricism) or decreased production of ACTH by the pituitary (secondary hypoadrenocorticism)

- Fatigue, irritability, depression, weakness, and hypotension.
- Generalized hyperpigmentation of the skin ("bronzing").

Front 16

Neurofibromatosis
(p. 458-460)

Back 16

Relatively common genetic disorder characterized by multiple neural tumors and other abnormalities such as skin changes and bone deformities.
- Increased risk of malignant peripheral nerve sheath tumor (found in about 5% of patients with NF 1) as well as other malignancies.