Orofacial Pigmentation Flashcards
Oral mucosa
Mucous membrane which lines the inside of the mouth
Oral mucosa epithelium
SSE
Underlying ct -lamina propria
Pigmentation
Common
Harmless
white patches of skin become darker in colour than surrounding skin
pathology of pigmentation
Two things:
1. abnormally high conc of melanocytes producing melanin
2. hyperactive melanocytes
ABCDE for identifying skin lesions associated with malignant melanoma
Asymmetry
Border irregularity
Colour variation across the lesion
Diameter of the lesion > 6mm
Evolution - rapid changes occurring in the lesion
causes of pigmentation
- Inherited (physiological)
- Acquired (local causes - medication) (systemic causes - malignancy)
physiological pigmentation
multifocal pigmentation
african/asian heritage
all ages
M:F
Brown/Dark patches
Symmetrical distribution
anterior labial mucosa/palatal mucosa
homogenous in appearance
diagnosis is clinical
biopsy required
no tx
Melasma (Cholasma)
Chronic skin disorder causing facial pigmentation
Macules or flat brown patches
F>M
Overproduction of melanin
Triggers (exposure to sun)
Tx (managed by underlying cause Tx. Topical agents prevent new pigment formation)
Foreign Body Tattoos
Introduction of coloured foreign material into soft tissues
Amalgam tattoos
Solitary asymptomatic
Mandibular gingivae or alveolar ridge, palate, buccal mucosa
Ethnobotanical tattooing
Traditional gingival tattooing
Aesthetic appeal
Black hairy tongue
Benign
Brown black coating on dorsal surface
Conservative tx
Melanotic macule
Solitary lesion
Increase in melanin deposition
<1cm
1:1000 adults
M:F
Lower lip, ant gingivae, buccal mucosa
Vascular malformation
Tongue, lips, buccal mucosa
Well circumscribed flat or raised blue coloured lesions
Diascopy to check whether lesions are vascular
TX- surgically excised/cryotherapy/sclerosing agents
Smokers melanosis
Contents of tobacco thought to stimulate melanin production
diffuse pigmentation affecting anterior labial mucosa, palate and buccal mucosa
clinical diagnosis
Post inflammatory pigmentation
Melanin hyperpigmentation
chronically inflamed oral mucosa
a-MSH by oral melanocytes
Manifests as a single or multiple brown-black patches, which may persist for a long time after the resolution of the inflammatory process
Medication caused pigmentation
Stimulation of melanin production by melanocytes
Palate, buccal mucosa, gingivae
Clinical diagnosis
Discontinuation in medication sometimes tx
Systemic cause of pigmentation [Peutz-Jegjhers]
Autosomal dominant condition
Numerous pigmented lesions on lips, buccal mucosa, palms and soles
Intestinal polyps
Increased risk of gastrointestinal malignancy
Systemic cause of pigmentation [Thrombocytopenia]
Reduction in number of circulating platelets (inc production of platelets/inc destruction/splenic sequestration)
Petechiae and purpura of mucosa, tendency to bruise, spontaneous bleeding, epistaxis, melena, hematuria
diagnosed on blood count and film
identification and correction of underlying cause
Systemic cause of pigmentation [Sturge-Weber Syndrome]
Angiomatous defects associated with the distribution of one or more branches of the trigeminal nerve
Port wine stain appearance of the skin of the face
Contralateral hemiplegia, epilepsy
I/O gingiva and soft tissues affected region may appear blue and swollen
Risk of bleeding
Systemic cause of pigmentation [heriditary hemorrhagic telangiectasia]
rare, autosomal dominant
dilatation of terminal blood vessels of skin and mucous membranes
bleeding is frequent
diagnosis on clinical and familial findings
tx based on symptoms
Systemic cause of pigmentation [Endocrinopathy]
Addison’s disease
- rare
- destruction of adrenal cortex due to infection/autoimmune/malignant infiltration
Addison’s disease
Insidious presentation
Lethargy
Depression
Anorexia
Weight loss
Postural hypotension
Malignant Melanoma
Malignant neoplasm of melanocytes
Uncommon - 1.6%
Middle aged males
M>F
I/O arise de novo
asymptomatic
palate/maxillary gingivae
mandible/tongue/buccal mucosa
Management of Malignant Melanoma
Surgical excision
Adjunctive therapy
