Pigmented LEsions

Pigmented LEsions

1. Seborrheic Keratosis

   • does not occur in oral cavity
   • well defined
   • reach size of 2cm
   • stuck on skin appaerance
   • AA dermatosis papulosa nigra. zygomatic or perioorbital region
   • horn cyst in the histology

2. Actinic Lentigo/age spot. liver spot, solar lentigo

   • not in oral cavity
   • chronic UV light exposure
   • flat, brown on skin
   • DOES not undergo malignant transformatio

3. Melasma

   • women
     • oral contraceptives
     • pregnant
   • sun exposure
   • no potential for malignant transformation
   • Mask of pregnancy

4. Oral melanoacanthoma

   • epitheliem with be aconthotic so thick
     • dendritic melanocytes in epithelium more thin and tapered
   • reactive asymptomatic lesion
   • can rapidly grow
   • biopsy tot rule out melanoma
   • dark brown t
   • smooth and flat can be elevated
   • found on bucccal mucosa
   • acquired benign

5. melanotic macule/ Focal melanosis/ labial melanotic macule

   • unknown ideology
   • not result of UV
   • flat brown discoloration
   • lower lip near vermillion border
   • buccal mucosa , gingigiva, and palate
   • solitary or multiple leesion. well demarcated and uniform asymtptomtic

6. NEVUS

   • congential or develipment malformation of skin or mucosa
   • mole
   • intradermal (skin)/ intramucosal (oral cavity )
     • theques necus cells with connective tissue
     • nevus cells ovoid cells with unifrom nuclei
   • junctional
     • nevus cells along basal cell layer
   • compound
     • nevels cell occur along basal cell layer AND connectiv tissue
   • blue/ dermal melanocytoma, jadassohn tieche
     • Most common location : hard palate
     • tyndal effect is why it is blue
       • blue has shorter wavelenth
     • macule or dome shaped, blue or black color
     • instead of being round the blue nevus are spindle shapred and elongated in connective tissue
     • surgical excision

7. Amalgam Tattooo

   • discolartion of oral mucosa,
   • ndontic rerotfill pieces fall into extraction socket fine particales
   • black , blueu or gray macule ,
   • gingiva, alveolar musosa, or buccal mucosa,
   • on radiograph fragments small in size

8. Systemic Metallic intoxication

   • lead plumbism
     • most widespread envromental toxin affecting children
     • oral findings
       • blue line on gingiva burton line
       • grey areas on buccal mucosa and tongue
       • tongue thursting
       • excessie salivaton
       • metallic taste
       • advanced periodontal disease
   • Mercury Poising
     • chronic form in adults
       • nueroligicall symptoms (erethism)
         • Tremors, memory loss , delirium
       • Mad as a hatter hat makers were exposed
       • oral findings
         • metallic tast, enlarged and inflmaed salivary glands
         • gingiva can be blue-gray black
         • destroy alvvelolr bone with loss of teeth
     • chronic form in infants/children
       • ACRODYNIA/ PINK DISEASE SWIFT DISEASE
         • erythmatous and prurititic rash with desquamation of palms and soles
         • patches of hair pulled out
         • increased lacrimation neurlogic symtoms and hypertension
         • oral changes
           • excessive salivation , preamture loss of teeth bruxism, ulcerative gingivitis
   • Silver Argyria
     • chronic toxicity
       • affects liver, spleen, GI tract, respiratory system
       • diffuse grayish discoloration on sun exposed areas
       • oral cavity
         • slate-blue silver line on gingival marginas initial sin
         • diffuse blue-black discoloration on oral mucosa
   • GOLD
     • chyriasis slate blue discoloration
   • BISMUTH
     • clinical features intraorally
       • Blue-gray line along gingival margin Burning Ulceration Stomatitis If chew tablets-black discoloration on filiform papillae
   • arsenic
     • Diffuse macular hyperpigmentation Hyperkeratosis on palms of hands/soles of feet • Oral findings rare Excessive salivation Necrotizing ulcerative stomatitis

9. drug related discolorations

   • clinical features
     • BONE dark green, oral mucosa appears blue gray, linear band of the ginigiva near the mucoginigval junction broad disolation on hard palate, teeth may darkly stained from affected dental pulp

10. melanotic neuroectodermal tumor of incanfy

    • frequent site anterior maxilla with male predilection
    • clincial features
      • rapid, expanind mass
      • blue or black
      • destroys underlying bonee
      • displaces teeth
    • high urine levels of VMA(vanillymandelic acid
    • benign

11. Smoker Melanosis

    • cigareet smokers anterior facial gingiva pigmentation seen
    • pipe smokers
      • bucccal mucosa and commisure
    • Reverse smokers
      • lit end of cigaretter in mouth hard palate

12. peutz jeghers syndrome

    • clinical features
      • freckle like lesion on hands peioral skin oral mucosa
      • oral lesions
        • extension of freckles brown to blue gray macules
          • seen on labial/buccal mucosa, tobuge vermillion zone
      • intestinal obstruction
      • intestinal polyps
        • hamartomatous growths
        • polyps are not premalginant
      • develop gastiotesinal adenocarncioma

13. MELANOMA

    • oral RARE
      • hard palate or max gingiva
      • brown or blakc with irregular boder
      • diffuse spread nodular appearance
    • Assymetry, Boder irregualrit, color, diamet >6mm ,, evolving

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