OD 37 - Oral mucosal pigmentation

Question 1

What is a graphite tattoo?

Answer 1

Black-grey

Normally on hard palate where pencil lead implants accidentally (kids)

Question 2

What are melanotic macules?

Answer 2

Focal macular pigmentations of oral mucosa/lip caused by increased melanin pigmentation in basal cell layer
Freckles of lip/mucosa
Don’t darken on sun exposure
No malignant potential - epidermis normal

Question 3

What is the correct term for a mole?

Answer 3

Naevi

Question 4

What is a naevi and how does it present orally?

Answer 4

Proliferation of melanocytes
Rare - look like melanomas
Normally on HP
Excision of all lesions - as 1/3 turn malignant

Question 5

What is a melanoma?

Answer 5

Aggressive tumour of melanocytes

Question 6

What does oral melanoma present as?

Answer 6

Rare
Asymptomatic pigmented plaques with asymmetrical irregular borders
Lesions dark brown/black
Can be rapidly enlarging nodules = cause ulceration, bleeding, pain and tooth mobility
Normally metastatic

Question 7

What are the 2 growth phases of oral melanoma?

Answer 7

Radial growth phase = in situ/ superficial melanoma

Vertical growth phase = invasive melanoma

Question 8

What does smokers melanosis look like and where?

Answer 8

Patchy brown macular pigmentations

On buccal mucosa 5-10mm

Question 9

What is Peutz-Jehgers syndrome?

Answer 9

Mucocutaneous hyper pigmentation and GI hamartomatous polyposis

Question 10

What is the oral presentation of Addison’s disease?

Answer 10

Hyperpigmentation of skin/mucous membranes - diffuse darkening/bronzing

Question 11

What is the cause of Addison’s disease?

Answer 11

Deficiency of cortisol by adrenal glands

Increased ACTH

Question 12

What is the most common drug to cause oral pigmentation? and does it look like?

Answer 12

Minocycline causing grey-blue appearance