Localised Pigmentation Flashcards
Name 10 causes/conditions that contribute to localised oral pigmentation?
Black hairy tongue
Habits
Diet/beverages
Amalgam tattoo
Graphite tattoo
Metal salts
Ethnobotanical tattooing
Melanotic macules
Malignant melanoma
Kaposi’s sarcoma (tumour of blood vessels driven by immunosuppression)
What is ethnobotanical tattooing?
= aesthetic gingival tattooing performed on adolescent females as a rite of passage in Africa
(done w/ soot, charcoal, thorns or needles)
What is black (brown) hairy tongue?
= elongation of filiform papillae, fungi, food & bacteria accumulate in papillae
May be assoc. w/:
heavy smoking
xs use of antiseptic m/w
broad spectrum antibiotics
- cause: alteration in the flora of the dorsum tongue -> black pigment producing bacteria + fungi to overgrow
- -may alternate w/ areas of white hairy tongue
Management:
- reassurance + information
- improved OH
- smoking cessation
- increased water intake of fibrous diet (wholemeal, fruit)
- gentle tongue brushing (avoid excessive tongue brushing, often tends to make already prominent filiform papillae worse)
- H2O2 M/W (hydrogen peroxide)
What is metal salt deposition?
= deposits of metallic sulphides along gingival margin (mainly lead but also mercury)
- salts present in crevicular fluid precipitated as sulphides by H2S produced from plaque microorganisms
Presentation:
linear grey/black lines along gingival margin (lead lines or Burton’s lines)
- can be confused w/ subgingival calculus
What is an oral melanotic macule + state is management?
- benign, localised areas of oral pigmentation (focal increase in melanin production)
- can affect any mucosal surface
- rare in oral mucosa
- lesions on the lip may represent reaction to sun damage
- uniformly flat, brown or black macules
- distinct borders, usually <0.5cm
management:
- benign
- often best to excise to make diagnose + avoid long term follow up
- lip lesions may be monitored if no suspicious features (as biopsy is not aesthetic in this region)
What is an Oral Melanoma?
- more common in Africans + Japanese
- common IO location: palate, lips + gingivae
- clinical appearance:
darkish brown to black - 30% are amelanotic melanoma (not pigmented - pale)
irregular poorly defined borders + colour distribution
thickening (nodular phase) w time –> bleed
Poor prognosis due to delayed diagnosis, often histologically aggressive:
- early metastasis owing rich blood + lymphatics –> difficulties w local clearance (metastasis in lymph nodes, lung + liver)
What is an amalgam tattoo, state key histological facts?
aka focal agyrosis
- common along mandibular gingiva + alveolar mucosa
- may follow XLA of amalgam filled tooth or removal of amalgam resto, or from apicectomy w amalgam filling material
- colour varies from slate grey, blue to black macules - no elevation
- no change in size- margins may blur w/ time
Histology (taken due to concerns of looking like malignant melanoma):
- lamina propia - finely granular black/brown pigment encasing elastic fibres + basement membrane of superficial capillaries
What is a Graphite Tattoo, state key histology? Is biopsy compulsory?
- pt sucked on sharp end of lead pencil, thus lead enters the ST
- very common
- typically anterior palates of younger children
MANDATORY biopsy to rule out malignancy (abundance of granulation tissue, destruction of labial cortical bone + residues of solid black granules)
Histology:
mild chronic inflammatory cell infiltrate, multinucleated giant cells, solid granules consistent with/ pencil graphite
What is the management of amalgam + graphite tattoo?
Radiographs (might show amalgam in tissue, but depends on density of surrounding bone + KV)
Reassure pt - no health hazard
Observation or excision if clinical doubt
removal by Q-switched ruby laser
What is Eccymosis?
= BRUISING
bright red or blue in colour
hx of trauma (e.g. fractured mandible)
Spontaneous lesions may represent underlying platelet or coagulation disorders
What is Varices?
Varices represent an abnormal venous dilation
- occurs over age of 40
- lip + sublingual areas = most common
Features:
painless
blue, lobulated
blanch on pressure
can feel thickened + hard in areas due to thrombosis w/ calcified blood clots
Tx:
reassurance, observation
excision or sclerotherapy or laser ablation
Exam q, Bucchy lec:
Which types of oral pigmentation are caused by an increase of melanin production? (7)
- Racial pigmentation
- Peutz-Jegher’s
- Post-inflammatory hyperpigmentation
- Addison’s disease
- Drugs
- Molasma
- Melanotic macule
Exam q, Bucchy lec:
Which types of oral pigmentation are caused by an increase in the no. of melanocytes?
- Naevi
- Melanoma
