Oral Pigmentation

Question 1

hemangioma patterns

Answer 1

1. subepithelial
   - superficial - close to surface of mucosa and overgrowht of blood vessesl
   tongue or lip mucosa
2. intramuscular
   - may not see pigmentation
3. central
   - in bone in maxilla or mandible
   - madnible in female more

Question 2

sturge wever syndrome

Answer 2

encephalotrigeminal angiomatosis in the brain

- tramline - radio-opaque tracks and the facial skin - port wine stains

Question 3

hematoma aka

Answer 3

ecchymosis

Question 4

most common cause of ecchymosis

- elaborate

Answer 4

trauma

- common on labial buccal mucosa and starts with bright red – hemoglobin still carrying a lot of oxygen

Question 5

stages of ecchymosis and why

Answer 5

level of oxygen there

hemoglobin (more red more oxygen ) to hemosiderin (more brown / less oxygen)

remission in about two weeks

Question 6

two manifestations of ecchymoisis

Answer 6

1. traumatic

2. coagulopathic

Question 7

coagulopathic clinical manifestation of ecchymosis

Answer 7

multiple red or brown (hemosiderin) macules with history of

• hereditary coagulopathic disorders
• chronic liver failure

prolonged vlood prothrombin and partial thromboplastin time

Question 8

treatment for coagulopathic ecchymosis

Answer 8

consult physician

Question 9

treatment wit traumatic ecchymosis

Answer 9

resolve quickly, no tx required

Question 10

melanosis

Answer 10

benign
- does NOT increase in melanocytes - cell # keep the same but produce more melanin

cells normal **

multiple or diffuse lesions with an increase in melanin pigment synthesis by basal layer melanocytes without an increase in the number of melanocytes

Question 11

drug-induced melanosis

Answer 11

localized melanosis at the hard palate or diffuse melanosis in the oral mucosa caused mainly by antimalarial drugs

Question 12

drug-induced melanosis

Answer 12

localized melanosis at the hard palate or diffuse melanosis in the oral mucosa caused mainly by antimalarial drugs

Question 13

cigarette smoking melanosis

Answer 13

diffuse macular melanosis of the buccal mucosa, lateral tongue, palate and floor of the mouth

Question 14

neurofibromatosis melanosis

Answer 14

autosomally dominant inherited disease with both nodular neurofibromas and cafe-au-lait pigmentation on the skin and oral mucosa

Question 15

peutz jeghers synrome associated with

Answer 15

hereditary intestinal polyposis

there are multiple melanotic brown macules on the perioral areas

ages 20-40!!!

before and after nope

Question 16

addisons disease and melanosis?

Answer 16

yes
- hypoadrenocorticism with patchy melanosis of the oral mucosa and bronzing of the skin

only involved melanin bu NOT the number of melanocytes

Question 17

mangement of melanosis

Answer 17

determine the cause and follow by cause - based treatment

biopsy if necessary- except for physiologic melanosis to confirm dx of lesions

no surgical removal is necessary as teh lesions have no premlaignant potential

Question 18

biopsy of melanosis

Answer 18

yearly

Question 19

oral melanotic macule

Answer 19

focal melanosis
increase in melanin pigment synthesis by basal layer melanocytes without an increase in the number of melanocytes

multiple macules in 17%

lesions are small (less than 1 cm)

flat and brown macules resemble freckles with irregular outline

Question 20

location of oral melanotic macule

Answer 20

lower lip 33
palate 20
gingiva 20
buccal mucosa 20

Question 21

melanotic macule benign?

Answer 21

yes – do not change in size or inttend to change in color

but if change – Not a melanotic macule

take picture and document if any changes occur – then the dx changes

Question 22

melanocanthoma

Answer 22

truama associated and deeply pigmented reactive lesion with melanin containing dendritic cells (immune cell) extended high into a thickened spinous layer of the mucosa

Question 23

management of melanotic macule

Answer 23

excision biopsy is necessary to exclude malignant melanoma in the cases with relatively short history

follow up (w/out) biopsy) is necessary for the lsions presented for 5 or more years without change in size or color

b/c usually a single benign lesion – need to follow it for any change in color and size – need to do biopsy

Question 24

pigmented cellular nevus

Answer 24

congenital or developmental benign proliferation of melanocytes in the skin or oral mucsoa

Question 25

nevocellular nevi evolutionary stages

Answer 25

1. neural crest –> melanocytes –> migrate to the basal layer of the epithelium
2. junctinal nevie — proliferation of the basal layer melanotic nevus cells localized at the epitheliomesenchymal junction – showing clincially FLAT
3. COMPUND NEVI – clusters of more proliferated nevus cell dropping down from the basal layer into connective tissue classified as compound – showing clinically raised - dome shaped appearance
4. INTRAMUCOSAL NEVI — in later puberty nevus cells in compound nevi lose their continuity with the surface epithelium and become localized to the deeper connective tissue, classified as intramucosal nnevi - showing clinicnally ELEVATED nodules

Question 26

blue nevus never what

Answer 26

never reach basal cell layer of epithelium — proliferation of the spindle shaped melanotic nevus localized deep in the CT , classified as blue nevi – showing lincially flat or nodule

horizontally arranged **

Question 27

color of pigmented cellular nevi?
borders?
location?

Answer 27

most in brown and uniform color – but 3% unpigmented (lack tyrosinase – just raised lesion)

borders = smooth!!

location = hard palate and buccal mucosa

(diff then macula which is lip)

Question 28

treatment and prognosis of

Answer 28

2 mm margin after excision!

all intraoral nevi should be sugicall and excisionally (>2mm margin) removed for histopatholgic diangosis

intraorla malignant melanomas are invariably compound therefore when an intraoral nevus shows microscopic evidence of junctional activity, premelanomatous change should become suspect

intramucosal and blue nevi have less potential to melanoma

Question 29

intraoral melanoma clincial manifestations

Answer 29

hard palate 50
upper gingiva 25

with rpid growth to over 1 cm

Question 30

intraoral melanoma clincial manifestations

color

Answer 30

mixture of brown, black, red, white, and blue

15% unpigmented oral melanomas are red – less well differentiated

Question 31

treatment and prognosis of melanoma

Answer 31

intraoral melanomas seem more aggresive with early metasteses to regional lymph nodes, lungs, liver, brain and bone

Question 32

morphology of melanocytes and amount of melanin in melanoma?

Answer 32

doe NOT appear to affect the outcome

Question 33

most important for intraoral melanoma tx and prognosis?

Answer 33

early dx and surgical excision (2-5 cm free margin) plus block dissection of clincially involved lymph nodes are the only hope of cure

radiotherpay, chemotherapy and immunotherapy (interferon) are only palliation

the median survival rate is 2 years - 55 year survical rate is 20%

Question 34

manangement of amalgam tattos

Answer 34

excisional niopsy is recommended for histopathologic diagnosis

lesion is innocuous - no further tx

*if high copper amalgam - need to remove it cause causes a lot of inflammtion

Question 35

graphite tattoo

Answer 35

caused by pencil
- traumatic implantation of lead pencil on the palte

macular, focal, and grey black in color

management - with known history - no treatment necessary

Question 36

heavy metal ingestino

Answer 36

ingested pigments of lead, mercury, or bismuth extravasate from blood vessels in the area of increased capillary permeability (inflammed tissue - like gingivitis) –> deposition of pigments along the free marginal gingiva, showing gray to black color

pigmentation in the free margin