Oral pigmented lesions: Clinicopathologic features and review of the literature

Ro Gondak,Pa Vargas,Ma Lopes,J Jorge,R Da Silva-Jorge

doi:10.4317/medoral.17679

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.

Highlights

The color of oral pigmentation can vary depending on the quantity and depth or location of the pigment
The clinical aspects of pigmented lesions in the oral cavity are sufficient in establishing the diagnosis
The ABCD checklist that is commonly used to aid the identification of cutaneous melanoma may be of some utility in the clinical diagnosis of oral melanoma [38]

Summary

Introduction

The color of oral pigmentation can vary depending on the quantity and depth or location of the pigment. The surface shows brown pigmentation and those located deeper are black or blue. Melanin is produced by melanocytes in the basal layer of the epithelium and is transferred to adjacent keratinocytes via membrane-bound organelles called melanosomes. Melanin is synthesized by nevus cells, which are derived from the neural crest and are found in the skin and mucosa [1]. The melanocytes are present in any region of the oral cavity and can be present in reactive, benign or malignant lesions. Pigmentation derived from foreign bodies, heavy metal poisoning or drugs may promote pige919

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