Pigmented Lesions

Question 1

What is a pigmented lesion?

Answer 1

This is a lesion that has either external pigment (pt eaten something that has stained mucosa) or internal pigmentation (melanocytes produce melanin in the mucosa)

Question 2

What is racial pigmentation?

Answer 2

This is where theres melanin through the connective tissue giving brown change - gums make look more brown in colour

Question 3

What is the difference between brown lesions and melanin?

Answer 3

The difference is in the number of melanocytes and production of Melanin by melanocytes

Question 4

What are some examples of extrinsic pigment?

Answer 4

Tea
Coffee
CHX
Bacterial overgrowth

Question 5

What are some examples of intrinsic pigmentation?

Answer 5

Reactive melanosis

Melanocytic nevus

Melanoma

Question 6

What is a reactive melanosis?

Answer 6

This is where smoking triggers an increased deposition of pigmentation around melanocyte going small areas of melanosis

NORMAL NO OF MELANOCYTES PRDUCING INCREASED AMOUNT OF MELANIN

Question 7

What is melanocytes nevus?

Answer 7

This is the the melanocyte becomes abnormal and produces too much melanin

THIS IS WHEN NO OF MELANOCYTES INCREASE AND ALL PRODUCE SMALL AMOUNT OF MELANIN

Question 8

What is melanoma?

Answer 8

This is a cancer

Question 9

What are causes of generalised brown or black lesions? 4

Answer 9

Racial
Smoking
Drugs - contraceptive and tetracycline which stimulate production of melanin
Addisons disease

Question 10

What are causes of localised brown or black lesions?

Answer 10

Am
Melanotic neavus
Kaposis sarcoma

Question 11

What is an amalgam tattoo?

Answer 11

This is where mucosa is dark blue/black pigment lesion and histologically Am is a foreign body that has been phagocytksed by giant cells to be removed and taken elsewhere in mucosa so lesion spreads out over time = biopsy dx

Question 12

What lesions can we see on palate in smokers?

Answer 12

Smokers keratosis

REd/brown spot lesions - due to melanin

Question 13

How does Addisons disease result in brown lesions?

Answer 13

There is change in hormone ACTH which is increased resullting in melanocytes making more melanin so pigment increased in skin and mucosa

Question 14

Why do we biopsy lesions?

Answer 14

To identify or exclude malignancy
Identify dysplasia
Identify other diseases (Lichen plants - lymphocytic band)

Question 15

Whhat lesions do we refer?

Answer 15

Pts with abnormal or unexplained changes to oral mucosa

concerns of dysplasia risk - smoking, oral cancer hisotry

Question 16

What areas of mouth are high risk sites?

Answer 16

FOM
Soft palate
lateral border of tongue

Question 17

What do we not refer?

Answer 17

Geographical tongue
most white patch lesions