Blue, Brown, Gray and Black Lesions Flashcards
List the developmental lesions
-Physiologic pigmentation
-Peutz-Jeghers syndrome
List the injury lesions
-Amalgam tattoo
-Intentional tattoo
-Smoker’s melanosis
-Drug-related pigmentation
List the neoplastic lesions
-Melanotic macule
-Melanocytic nevus
-Blue nevus
-Melanoma
List the metabolic lesions
-Addison disease
Physiologic Pigmentation
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
“racial pigmentation”
Category
-Developmental
Etiology
-Increase in production of melanin by melanocytes
Demographics
-Patients with a darker complexion
Clinical Presentation
-Attached gingiva most common location
-Can be seen anywhere (even tips of fungiform papilla on dorsal tongue)
Diagnosis
-Established clinically
Tx
-No tx
Peutz-Jeghers Syndrome
-Category
-Etiology
-Clinical Presentation
-Diagnosis
-Tx
Category
-Developmental
Etiology
-Autosomal dominant genetic disease
Clinical Presentation
-Oral and perioral freckles that first present during childhood and adolescence (lips and cheeks)
-Skin and mucosal freckles
-Intestinal polyps (small bowel)
-Increased risk of malignancy (GI, pancreatic, breast, ovarian)
Diagnosis
-Family history
-Genetic testing
Tx
-Oral and perioral pigmentation persists throughout life and does not require tx
-Lifelong monitoring for development of neoplasia
Amalgam Tattoo
-Category
-Etiology
-Demographics
-Clinical Presentation
-Radiographic Presentation
-Diagnosis
-Tx
Category
-Injury
Etiology
-Amalgam becomes embedded in oral mucosa
Demographics
-Patients with a history of amalgam restorations
Clinical Presentation
-Black, blue or gray macules
-Gingiva, alveolar mucosa, and buccal mucosa most common
Radiographic Presentation
-May appear as a dense radiopacity
Diagnosis
-Radiograph
-Biopsy
-MUST be distinguished from melanocytic neoplasia
Tx
-No tx
Smoker’s Melanosis
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category
-Injury
Etiology
-Increased melanin production
-Protective response against noxious chemicals in tobacco smoke
Demographics
-Females affected with higher frequency
Clinical Presentation
-Anterior facial mandibular gingiva most common
-Multiple brown macules
Diagnosis
-Correlate clinical presentation with smoking history and medical history
-Biopsy if any doubt
Tx
-Pigmentation can disappear after smoking cessation
Drug-Related Pigmentation
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category
-Injury
Etiology
-Different for different medications
-Some chelate with iron or melanin and deposit in lamina propria
-Some stimulate melanocytes to produce melanin
Demographics
-Patient taking medications known to cause pigmentation
Clinical Presentation
-Diffuse, painless, symmetric, bluish-gray macular pigmentation of the hard palate
Diagnosis
-Correlation between initiation of the drug and onset of pigmentation
-Biopsy
Tx
-No tx
What medications are known to cause pigmentation?
-Minocyline
-Antimalarials (chloroquine, hydroxychloroquine, quinidine, quinacrine)
-Tranquiilizers (chlorpromazine)
-Chemotherapeutic agents (imatinib)
-Estrogen
-AIDS medications (zidovudine/AZT)
Melanotic Macule
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category
-Neoplastic
Etiology
-Increase in melanin and melanocytes
Demographics
-2:1 female predilection
-Average age of 42yrs
Clinical Presentation
-Solitary, uniformly tan to dark-brown
-Most common on lower lip
Diagnosis
-Biopsy (recent onset, large size, irregular pigmentation, unknown duration, or recent enlargement)
Tx
-No tx
Melanocytic Nevus
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
“mole”
Category
-Neoplasm
Etiology
-Benign localized proliferation of nevus (melanocytic) cells derived from the neural crest
Demographics
-10-40 cutaneous nevi per white adult (common)
Clinical Presentation
-Uncommon intraorally
-Junctional nevus (brown/black macule)
-Compound nevus
(brown/tan papule)
-Intradermal/intramucosal nevus (brown/tan papule with papillomatous surface - hair may grow from center)
Diagnosis
-Clinical diagnosis can be made on skin (biopsy if any doubt)
-Biopsy necessary if intraoral
-Biopsy necessary if >6mm
Tx
-Monitor for signs of change (small % develop into melanoma)
Blue Nevus
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category
-Neoplasm
Etiology
-Benign proliferation of dendritic melanocytes usually deep within CT
Demographics
-Female predilection
-Usually in children and young adults
Clinical Presentation
-Macular or dome-shaped, blue or blue-black
-Smaller than 1cm
-Any cutaneous or mucosal site
-Palate is most common oral location
Diagnosis
-Biopsy
Tx
-Surgical excision
Melanoma
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category
-Neoplasm
Etiology
-Malignancy of melanocytic cells
Demographics
-Risk factors for cutaneous melanoma:
1. Acute sun damage
2. Fair complexion (blonde hair, blue eyes)
3. Multiple moles, freckling, dysplastic nevi)
4. Family history
-Oral melanoma
1. 5th-7th decade of life
2. Male predilection
Clinical Presentation
- 25% head and neck
- 40% extremities
- <1% intraoral (palate and maxillary ginigiva most common sites)
-ABCDE of melanoma:
1. Asymmetry
2. Borders - irregular
3. Color variation
4. Diameter - greater than 6mm
5. Evolving
Diagnosis
-Biopsy
Tx
-Wide surgical excision
-Radiation
-Immunotherapy
-Depth of invasion is an important prognostic factor
-Oral mucosal melanoma has worse prognosis than cutaneous melanoma (<20% 5-yr survival)
Addison Disease (hypoadrenocorticism)
-Category
-Etiology
-Clinical Presentation
-Diagnosis
-Tx
Category
-Metabolic
Etiology
-Adrenocortical insufficiency secondary to:
1. Autoimmune adrenalitis
2. Tuberculosis
3. AIDS
4. Metastatic Cancer
-Increased ACTH production by anterior pituitary
Clinical Presentation
-Generalized hyperpigmentation of the skin (bronzing)
-Diffuse of patchy, brown, macular pigmentations of the oral mucosa
-Systemic symptoms (weakness, weight loss, irritability, depression, nausea, vomiting, hypotension)
Diagnosis
-Decreased serum cortisol levels
-Increased plasma ACTH levels
Tx
-Steroid replacement therapy
