Oral pigmented lesions: Clinicopathologic features and review of the literature

Abstract

Diagnosis of pigmented lesions of the oral cavity and perioral tissues is challenging. Even though epidemiology may be of some help in orientating the clinician and even though some lesions may confidently be diagnosed on clinical grounds alone, the definitive diagnosis usually requires histopathologic evaluation. Oral pigmentation can be physiological or pathological, and exogenous or endogenous. Color, location, distribution, and duration as well as drugs use, family history, and change in pattern are important for the differential diagnosis. Dark or black pigmented lesions can be focal, multifocal or diffuse macules, including entities such as racial pigmentation, melanotic macule, melanocytic nevus, blue nevus, smoker’s melanosis, oral melanoacanthoma, pigmentation by foreign bodies or induced by drugs, Peutz-Jeghers syndrome, Addison´s disease and oral melanoma. The aim of this review is to present the main oral black lesions contributing to better approach of the patients. Key words:Pigmentation, melanin, oral, diagnosis, management.

Melanoma of the Oral Cavity: an Analysis of 46 New Cases with Emphasis on Clinical and Histopathologic Characteristics

“…Due to the extreme variation of clinical impressions found in our series, a differential diagnosis for intraoral melanoma could include any of the following: (a) Benign pigmented lesions: amalgam tattoo, melanotic macule, melanotic nevus, melanoacanthoma, post-traumatic or racial pigmentation, pigmentation associated with systemic disease (e.g. Peutz-Jeghers syndrome, Addison disease), druginduced pigmentation, and vascular lesions, (b) Benign inflammatory or reactive lesions such as epulis, pyogenic granuloma, irritation fibroma, peripheral giant cell granuloma, and peripheral ossifying fibroma, (c) Malignant pigmented lesions such as Kaposi sarcoma, and (d) A wide variety of primary and metastatic non-pigmented malignancies [21]. The findings of our study reinforce the principle that even the most unsuspecting of lesions, such as those appearing like fibrous hyperplasias or epulides, merit investigation with possible biopsy for definitive diagnosis.…”

Solitary Pigmented Melanocytic Lesion on the Palatal and Gingival Mucosa: Should It Rise Dentist’s Concerns?

“…Therefore, in some cases, the histopathology and sometimes immunohistochemistry examination may be required. 3,5 In order to help clinicians to do a diagnostic pathway when finding pigmented lesions in the oral cavity, a flowchart for diagnosis and management of oral pigmented lesion had been proposed ( Figure 5). 2 When ones have classified the lesion to be melanocytic-related, clinical suspicion of malignancy in terms of ABCD checklist (asymmetry, border irregularities, color variegation and diameter > 6mm), recent history, age and the involved subsites should be assessed.…”

“…2 The diagnosis of lesions with "no or low suspicion of malignancy" such as oral manifestation of systemic disease, physiologic pigmentation, smoker's melanosis, may be made based on clinical information alone or may need histopathological assessment. 2,3,5 Eral, the pigmented lesions in the oral cavity are benign in nature, which required no treatment unless discomfort is present. However, special concerns have to be put on OMM.…”

“…The most common cause of endogenous color changes in the oral mucosa is hemoglobin, hemosiderin and melanin followed by vascular-and bilirubin-related oral pigmentation. 3 There are various manifestations of pigmentation in the oral cavity. The lesions could be a solitary to diffuse, small to large patches with a different number, distribution, shape and size, location, hue, and onset.…”

“…The incidence of intra-oral hyperpigmentation can occur as a physiological process; developmental; certain medication uses such oral contraceptives, high serum concentrations of ACTH (adrenocorticotropic hormone); post inflammatory changes, genetic or autoimmune disease, a neoplastic condition or idiopathic. 3,4 It is important for a dentist to investigate the possible causes of the oral hyperpigmentation regarding the presence or absence systemic signs and symptoms. The decision to plan for a tissue biopsy is important for the lesions which suspected etiology of the hyperpigmentation could not be warranted.…”