ORAL PATH pigmented lesions

Question 1

2 categories of oral pigmentation?

Answer 1

exogenous
endogenous

Question 2

what are the types of exogenous oral pigmentation?

Answer 2

superficial staining of mucosa (foods, drink, tobacco)
black hairy tongue
foreign bodies - amalgam tattoo
heavy metal poisoning
some drugs, NSAIDs, antimalarials, chlorhexidine

Question 3

what is black hairy tongue?

Answer 3

papillary hyperplasia and overgrowth of pigment producing bacteria

Question 4

what type of pts is black hairy tongue common in?

Answer 4

smokers

Question 5

black hairy tongue treatment?

Answer 5

no tx
good OHI, tongue scarping

Question 6

how does an amalgam tattoo come about?

Answer 6

amalgam introduced into the socket/ mucosa during tx

Question 7

how does an amalgam tattoo present?

Answer 7

symptomless blue/ black lesion

Question 8

what is the histology of an amalgam tattoo?

Answer 8

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

Question 9

treatment for amalgam tattoo?

Answer 9

none required
removal for aesthetics

Question 10

when would you excise an amalgam tattoo?

Answer 10

if not seen on a radiograph - must confirm diagnosis

Question 11

name types of endogenous oral pigmentation?

Answer 11

melanotic macule
mucosal melanoma
melanotic neuroectodermal tumour of infancy

Question 12

describe a melanotic macule

Answer 12

well-defined small flat brown/ black lesion

Question 13

cause of melanotic macule?

Answer 13

increased activity of melanocytes

Question 14

is a melanotic macule of concern?

Answer 14

no - its benign

Question 15

where are melanotic macules commonly found?

Answer 15

buccal mucosa
palate
gingivae

Question 16

melanotic macule treatment?

Answer 16

frequently excised to confirm diagnosis and exclude diagnosis

Question 17

histopathology of melanotic macule?

Answer 17

increased melanin pigment in basal keratocytes - NOT increased number of melanocytes

Question 18

what is a mucosal melanoma?

Answer 18

malignant neoplasm of mucosal melanocytes

*primary mucosal melanoma is rare but can occur

Question 19

where is the most common H+N sites for mucosal melanomas?

Answer 19

nose and maxillary sinus

Question 20

where are the most common intraoral sites for mucosal melanomas?

Answer 20

hard palate and maxillary gingivae

Question 21

what do mucosal melanomas look like?

Answer 21

dark brown or black, if not pigmented then red

Question 22

are mucosal melanomas symptomatic?

Answer 22

not initially
may remain unnoticed until pain, ulceration, bleeding or a neck mass

Question 23

do mucosal melanomas metastasise?

Answer 23

regional lymph node and blood-borne metastases are common

very invasive, metastasise early

Question 24

histopathology of mucosal melanoma?

Answer 24

highly pleomorphic neoplasms, cells appear epithelioid or spindle-shaped
amount of melanin is variable

Question 25

treatment for mucosal melanoma?

Answer 25

surgical resection is mainstay treatment
adjuvant radiotherapy
immunotherapy

Question 26

what is a melanotic neuroectodermal tumour of infancy?

Answer 26

locally aggressive, rapidly growing pigmented mass which presents in infants < 1 years old
neural crest cell origin? pathogenesis unknown

Question 27

where do you commonly find melanotic neuroectodermal tumour of infancy?

Answer 27

anterior maxillary alveolus

Question 28

histopathology of melanotic neuroectodermal tumour of infancy?

Answer 28

tumour comprises 2 cell population - neuroblastic cells and pigmented epithelial cells

Question 29

treatment of melanotic neuroectodermal tumour of infancy ?

Answer 29

complete local excision is treatment of choice
tumour of uncertain malignant potential
can recur

Question 30

do melanotic neuroectodermal tumour of infancy metastasise?

Answer 30

small number do, yes