Electron Microscopic X‐ray Microanalysis of Metals Deposited in Oral Mucosa

Abstract

A 35-year-old woman exhibited bluish-brown discoloration of her buccal mucosa suggesting malignant melanoma. Histopathological examination revealed that the pigment was not melanin but caused by metal deposits. Electron microscopically, metallic particles were located on the lamina densa of basal laminae at mucosal epithelium, nerve fibers, and blood vessels and on the microfilaments of elastic fibers as well as in macrophages and fibroblasts. Electron microscopic point X-ray microanalysis revealed that these metallic particles were composed of Ag, Se, Fe, Co, Cu, and S. Analysis suggests that these metals were derived from dental amalgam and that the discoloration was caused by amalgam tattoo.

Pigmented fungiform papillae on the tongue in an Asian man

“…Other authors have reported pigmented fungiform papillae in association with iron deficiency anaemia 5 and ichthyosis linearis circumflexa 4 . Discoloration of the oral mucosa because of melanin is also reported in metabolic diseases such as Addison's disease, von Recklinghausen's syndrome 8 and in melanocytic naevi and melanoma 9 . Haemochromatosis, pernicious anaemia and scleroderma have also been associated with hyperpigmented lingual patches 5 (Table 1).…”