ORAL PATH pigmented lesions Flashcards
2 categories of oral pigmentation?
exogenous
endogenous
what are the types of exogenous oral pigmentation?
superficial staining of mucosa (foods, drink, tobacco)
black hairy tongue
foreign bodies - amalgam tattoo
heavy metal poisoning
some drugs, NSAIDs, antimalarials, chlorhexidine
what is black hairy tongue?
papillary hyperplasia and overgrowth of pigment producing bacteria
what type of pts is black hairy tongue common in?
smokers
black hairy tongue treatment?
no tx
good OHI, tongue scarping
how does an amalgam tattoo come about?
amalgam introduced into the socket/ mucosa during tx
how does an amalgam tattoo present?
symptomless blue/ black lesion
what is the histology of an amalgam tattoo?
pigment is present as widely dispersed, fine brown/ black granules or solid fragments of varying size
associated with collagen and elastic fibres and basement membranes
treatment for amalgam tattoo?
none required
removal for aesthetics
when would you excise an amalgam tattoo?
if not seen on a radiograph - must confirm diagnosis
name types of endogenous oral pigmentation?
melanotic macule
mucosal melanoma
melanotic neuroectodermal tumour of infancy
describe a melanotic macule
well-defined small flat brown/ black lesion
cause of melanotic macule?
increased activity of melanocytes
is a melanotic macule of concern?
no - its benign
where are melanotic macules commonly found?
buccal mucosa
palate
gingivae
melanotic macule treatment?
frequently excised to confirm diagnosis and exclude diagnosis
histopathology of melanotic macule?
increased melanin pigment in basal keratocytes - NOT increased number of melanocytes
what is a mucosal melanoma?
malignant neoplasm of mucosal melanocytes
*primary mucosal melanoma is rare but can occur
where is the most common H+N sites for mucosal melanomas?
nose and maxillary sinus
where are the most common intraoral sites for mucosal melanomas?
hard palate and maxillary gingivae
what do mucosal melanomas look like?
dark brown or black, if not pigmented then red
are mucosal melanomas symptomatic?
not initially
may remain unnoticed until pain, ulceration, bleeding or a neck mass
do mucosal melanomas metastasise?
regional lymph node and blood-borne metastases are common
very invasive, metastasise early
histopathology of mucosal melanoma?
highly pleomorphic neoplasms, cells appear epithelioid or spindle-shaped
amount of melanin is variable
treatment for mucosal melanoma?
surgical resection is mainstay treatment
adjuvant radiotherapy
immunotherapy
what is a melanotic neuroectodermal tumour of infancy?
locally aggressive, rapidly growing pigmented mass which presents in infants < 1 years old
neural crest cell origin? pathogenesis unknown
where do you commonly find melanotic neuroectodermal tumour of infancy?
anterior maxillary alveolus
histopathology of melanotic neuroectodermal tumour of infancy?
tumour comprises 2 cell population - neuroblastic cells and pigmented epithelial cells
treatment of melanotic neuroectodermal tumour of infancy ?
complete local excision is treatment of choice
tumour of uncertain malignant potential
can recur
do melanotic neuroectodermal tumour of infancy metastasise?
small number do, yes
