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19 Cards in this Set

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  • Back
Pigmented lesion usually seen on attached gingiva that usually has a history of long duration.
- May be increased in pregnancy
Physiologic (racial) Pigmentation (Melanoplakia)

HISTO - Melanin is secreted by the melanocytes and accumulates in the basal cell layer.
Smokers Melanosis
- seen in 21% of smokers
- appears as brown patch several cm in diameter
- Most common area is mandibular anterier gingiva, buccal mucosa, palate, etc.
- Amount of pigmentation appears to be related to amount of tobacco consumed
- May disappear months to years after cessation of smoking. Not pre-malignant.
Oral Melanotic Macule
- Occurs on oral mucosa (vermillion border and gingiva)
- Usually < 7mm
- 2:1 Female predilection
- Do not usually enlarge after diagnosis
- Not related to sun exposure.
An area of increased melanin pigmentation mainly within the basal cell layer (w/out an increase in the number of melanocytes) That is related to sun exposure.
Ephelis (Freckle)
- usually > 5 mm in diameter
- usually occurs on lip (85% lower lip)
Present for a long time
Present for a long time
Pigmented Cellula Nevus (mole)
- Does not blanch (may not be pigmented)
- Most frequently on palate (most common intraoral site), gingiva, Buccal mucosa (2nd most common intraoral site) and lips.
- Usually less than 6 mm
Most common of all human "tumors" but really rare in the oral cavity.
later stage: Nevus cells are no longer within epithelium but are within the underlying connective tissue.
later stage: Nevus cells are no longer within epithelium but are within the underlying connective tissue.
Intramucosal nevus (pigmented cellular neveus, mole)
- Most common intraoral nevi
nevus cells are located at the junction of epithelium and CT
nevus cells are located at the junction of epithelium and CT
Junctional nevus

Other variants
- Blue nevus (2nd most common oral nevi) usually hard palate
- Congenital melanocytic nevus
- Halo nevus
- Spitz nevus (Benign juvenile melanoma)
Smoker melanosis
Malignant Melanoma
- 3rd most common cancer of skin (83% of all deaths due to skin cancer)
- Sunlight is an important etiologic factor
- Ulceration is common
Two phases of growth.
- Radial-growth phase: cells spread laterally but stay confined to epithelium - better prognosis.
- Vertical growth phase -Malignant cells begin to invade underlying connective tissue.
Acral lentiginous melanoma
- most common form in the oral cavity
- This palatal melanoma demonstrates numerous atypical melanocytes in the basilar portion of the epithelium with invasion into the superficial lamina propria.
Three common types of Melanoma
Superficial spreading melanoma (70% of all melanomas)
- Most common on backs of males and legs of females.
Nodular melanoma (15%)
Lentigo Melanoma (5-10%)

Remember ABCDE
Oral malignant melanoma
- Uncommon neoplasm of the oral mucosa (primary melanoma of the oral cavity is rare. Melanoma that aries on the skin metastasize to the oral cavity.
- 80% on the maxillary ridge and palate
-Frequently see focal pigmentation of mucosa several months or years before malignancy
- Poor prognosis for oral melanoma
Treatment = radical surgery, chemotherapy, & radiation
Addison's disease
- Generalized weakness, fatigue. Hypotension.
- Generalized abnormal pigmentation (bronzing of skin and mucous membranes. Oral pigmentation varies from light brown to almost black, especially gingiva, lateral tongue, buccal mucosa and lips.
Addison's Disease
- Destruction of adrenal cortex due to autoimmunity, TB, tumors, AIDS, etc.
- Decreased steroid levels stimulate pituitary ACTH output with increased levels of MSH (melanocyte stimulating hormone)
Treatment - exogenous steroids.
Peutz-Jeghers syndrom
- Childhood onset, familial condition
- Oral perioral melanotic macules
- intestinal polyposis
- Pigmentation of 1-5 mm found around lips, eyes, nose...
- Oral pigmentation includes buccal mucosa, gingiva, palate (seldom tongue)
- Polyps may cause abdominal pain and cause obstruction due to intussusception.
Amalgam Tattoo.
- Blue/black, most common intraoral soft tissue pigmentation
- Several ways of implantation (including flossing)
HISTO - black granular material, usually lying free in the connective tissue.
- Must identify by radiograph or biopsy
Lead (Plumbism)
- GI disturbance, Peripheral neuritis, encephalitis, hypochromic anemia with basophilic stippling of RBC's, deposition of lead into growing bones.
Oral Manifestation
- Lead line in gingiva (due to formation of lead sulfide)
- Excess salivation and metallic tast
- Swelling of salivary glands
- May be deposited in deciduous teeth
Bismuth
- "Bismuth Line" may be seen in gingiva, buccal mucosa, lips and ventral tongue
- hydrogen sulfide, produced by oral bacteria, causes proliferation of granules of bismuth sulfide
- Prevention by good oral hygiene
- disappears after discontinuance of bismuth
Caused by drug used to treat acne
Caused by drug used to treat acne
Pigmentation Associated with Drug Minocycline Staining
- Staining of tissue due to ingestion of Minocycline (synthetic tetracycline).
- Generalized darker stain in alveolar, palate, vestibule...
- may be focal or generalized
- may affect roots of teeth
No treatment needed.