In the oral cavity, endogenous and exogenous pigment deposits reflecting a variety of systemic and local processes may be found. Evaluation of a patient presenting with a pigmented lesion should include a full medical and dental history, extraoral and intraoral examinations and, in some cases, biopsy and laboratory investigations. Oral pigmentation can be physiological or pathological, melaninassociated or nonmelaninassociated, and endogenous or exogenous. Pigmented lesions of the head and neck t here is a wide spectrum of pigmented lesions which present an oral mucosa or skin in the head and neck area. Oral melanoma and other pigmented lesions of the oral cavity. Oct 29, 2016 the identification of pigmented tissue within the oral cavity may present a diagnostic dilemma for the clinician. Remarkably, pigmented lesions located on the lips are more easily accessible and thus rather simple to examine by means of dermoscopy. Asymptomatic oral pigmentation at the site of oral volume 24 number 4 april 1991 melanoma and other pigmented lesions of the oral cavity 529 table i, a guide to the oral cavity examination materials needed.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. This article presents the differential diagnosis of and a management approach to pigmentary findings in the oral cavity. In this paper, an algorithm is proposed for the assessment of pigmented lesions of the oral cavity, and 3 patients with such lesions are. Ce 110 a guide to clinical differential diagnosis of oral. Reshna roy abstract mouth reflects the health status of an individual. Pigmented lesions of the oral and head and neck mucosa. Oral medicine pigmented lesions of the oral mucosa healthy oral soft tissues present a typical pink to red with slight variations of color due to many reasons presence or absence of keratin on the surface epithelium, the quantity, superficial or deep location of blood vessels in the subjacent stroma, the. Incidence four percent of all skin tumors and tumorlike lesions in. Melaninassociated pigmented lesions of the oral cavity oral mucosal melanocytes.
Pigmented lesions of the oral mucosa and perioral tissues. Stoopler and faizan alawi abstract pigmented lesions of the oral mucosa are encountered on a routine basis in clinical practice. Pigmented lesions of the oral cavity pocket dentistry. Practitioners will see many oral white lesions but few carcinomas. The manifestation of mucosal pigment is variable and can range from focal to diffuse macular coloration or from a small nodular growth to a large mass. Unlike cutaneous melanomas, oral melanomas are diagnosed late and have a poor prognosis regardless of depth of invasion. In addition, both benign and malignant lesions can be seen. Pigmented lesions of the head and neck pdf free pdf epub. This finding is inde pendent of the histologic appearance of the tumor. Many pigmented lesions of the oral cavity are associated with melanin pigment. White surface lesions epithelial thickening, surface debris, and subepithelial change generalized pigmented surface lesions localized pigmented surface lesions intravascular blood, extravascular blood, melanin pigment, and tattoo. There are various pigmented lesions present widely in an around the oral cavity which depicts whether they are benign or malignant. Oral pigmentation may be exogenous or endogenous in origin.
In this report we have documented the unusual occurrence of multiple intraoral junctional nevi in a patient. Even though epidemiology may be of some help in orientating the clinician and even though some lesions may. Pigmentation varies widely and may be present in a generalized fashion throughout the oral cavity or as an isolated focal lesion. Synthesis of melanin starting with the aminoacid tyrosine, which, with the enzyme tyrosinase, is a fundamental prerequisite, the successive steps in the production of melanin are as follows. In the oral cavity some of the pigmented lesions are physiologic, but most are considered pathologic. A pigment is a material that changes the color of light it reflects as the result of selective color absorption. Various premalignant lesions, particularly red lesions and some white lesions have a potential for malignant change.
One of the keys to improve accuracy in diagnosing oral lesions is forming an appropriate differential diagnosis. T he pigmented conditions located in the oral cavity have a diverse genesis ranging from vascular lesions to exogenous and endogenous pigmentations. Primary oral melanin pigmentations secondary oral melanin pigmentations oral nonmelanin pigmentations oral melanoclasias. These generalizations do not apply to the cat, where tumor morphology rather than site determines the malignant potential of the tumor. Pigmented lesions within the oral cavity may present a diagnostic dilemma for the clinician. The blueblack to brown lesions may be punctate macular or diffuse and may form melanoplakiabroad sheets of stained tissue figure 1. Moreover, although differences in colour can help to differentiate among pigmented lesions, the interpretation of colour can be subjective and is in. These color changes often occur due to deposition,production or increased accumulation of various endogenous or exogenous pigmented substances. Strength of recommendation sor a goodquality patientoriented evidence b inconsistent or limitedquality patientoriented evidence. Pigmented surface lesions of oral mucosa appear blue, brown, or black. This chapter discusses the etiology and presentation of pigmented lesions as well as certain systemic conditions associated with oral pigmentation. Common superficial oral lesions include candidiasis, recurrent herpes labialis, recurrent aphthous stomatitis, erythema migrans, hairy tongue, and lichen planus. Also known as hereditary intestinal polyposis syndrome it is rare autosomal dominant genetic disorder, characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyper pigmented macules on the lips and oral mucosa.
Diagnosis of pigmented lesions of the oral cavity is challenging. Heavy pigmentation of the attached gingiva in the region of the right lower canine in a smoker. After an overview of oral histology and physiology of melanocytes, a. May 05, 2012 pigmented areas may develop anywhere in the oral cavity, although the gingiva and buccal mucosa are common sites of deposition. With the exception of oral malignant melanoma omm, all pigmented primary lesions in the oral cavity are benign and treatment usually is required only when discomfort is present 16. A differential diagnosis for a pigmented lesion may include traumatic, reactive, neoplastic and systemic pathologies. Non tumoral pigmentations nonmelanin pigmented tumors or tumorlike lesions. Note that some soft tissue enlargements are pigmented, but they are discussed under soft tissue enlargements. Melanocytes were first identified in the oral epithelium by becker in 1927 6. Diagnosis of pigmented lesions of the oral cavity and perioral tissues is challenging.
Include melanoma in the differential diagnosis of oral pigmented lesions that have any features of cutaneous melanoma eg, asymmetry, irregular borders, or variable or changing color. Pigmented lesions of the oral cavity mirowski 2002. The differential diagnosis of mucosal pigmented lesions includes hematomas, varices, and petechiae which may appear to be pigmented. They are classified as generalized lesions, which are diffuse and multifocal, and localized lesions, which are unilateral and involve only one or several locations. Concerning oral pigmented lesions, dermoscopic examination is difficult to perform, since standard instruments for dermoscopy are specifically designed for evaluating pigmented lesions located on the skin. The pigment may be focal or diffuse and patchy, but is often regional to the lichenoid lesion fig. Figure 4 from pigmented lesions of the oral cavity. Oral lesions you cant afford to miss mdedge family medicine. However they must be able to recognize lesions at particular risk and several features which help to assess the likelihood of malignant transformation.
Generally, the clinical aspects of pigmented lesions in the oral cavity are sufficient in establishing the diagnosis. Most of the oral pigmentations are physiologic but sometimes it can be a precursor of severe. Pigmented oral lesion free download as powerpoint presentation. May 01, 2002 oral pigmented lesions oral pigmented lesions gaeta, giovanni m. In addition, pigmentation derived from foreign bodies, heavy metal poisoning or drugs may also promote pigmented lesions, which can vary in intensity and extension, and can occur in any sites of the oral cavity. Multiple focal pigmented lesions in the maxillary tuberosity. May 01, 2012 the melanocytes are present in any region of the oral cavity and can be present in reactive, benign or malignant lesions.
A concomitant finding is the presence of cafe au lait pigmentation. As the term implies, these lesions have the color of coffee with cream and vary from small ephelislike macules to broad diffuse lesions. In the oral cavity, this form of reactive pigmentation is most commonly observed in patients with clinical evidence of lichenoid inflammation. Tongue depressor, 4 x 4 inch gauze, gloves, light seated or semireclined 1. Therefore, classification has been made to quantify the size, color, location of the lesion. Jul 11, 2015 differential diagnosis of pigmented lesions of oral cavity the history should include the onset and duration of the lesion the presence of associated skin hyperpigmentation the presence of systemic signs and symptoms use of prescription and nonprescription medications, smoking habits the number, distribution, size, shape and colour of intraoral. Pigmented lesions of the oral cavity are of multiple origin. The identification of pigmented tissue within the oral cavity may present a diagnostic dilemma for the clinician. Pigmented lesions of the oral cavity the various lesions and should not be taken as absolute indicator of diagnosis. Such lesions represent a variety of clinical entities, ranging from physiologic changes to manifestations of systemic illnesses and malignant neoplasm. An overview of the recent literature and 3 case reports dentist case rep vol. Oral healthcare providers must assess several parameters associated with pigmented lesions,suchaslocation,shape,color,andsize.
218 1042 71 1471 257 1095 509 945 83 538 1591 142 296 787 1545 818 15 604 79 59 843 1597 547 1643 398 1105 1432 5 766 1096 1587 575 461 623 1048 368 876 284 962 786