Pigmented lesions

Question 1

What are the types of pigmented lesions of the oral mucosa?

Answer 1

Brown, blue, and black lesions due to deposition of endogenous or exogenous pigments.

Question 2

What are the endogenous pigments?

Answer 2

Hemoglobin, hemosiderin, and melanin.

Question 3

What causes brown pigmentation due to hemosiderin?

Answer 3

Blood extravasation as a consequence of trauma or a defect in hemostasis.

Question 4

What is the clinical significance of physiologic pigmentation?

Answer 4

Seen in blacks, Asians, and dark-skinned individuals; diffuse melanosis of facial gingiva, lingual gingiva, and tongue.

Question 5

What are the characteristics of pigmented lichen planus?

Answer 5

Typically presents as white lesions but can be associated with diffuse melanosis. Classic lesions are usually in buccal mucosa and vestibule, with white patches overlaying diffuse brown melanosis.

Question 6

What is Peutz-Jeghers syndrome?

Answer 6

A rare syndrome characterized by mucocutaneous melanin pigmentation and gastrointestinal polyps.

Question 7

What are the clinical features of Peutz-Jeghers syndrome?

Answer 7

Multiple brown macules on facial skin, circumoral, circumnasal, and circumocular areas, along with intestinal polyposis causing abdominal pain, hemorrhage, and intestinal obstruction.

Question 8

What causes endocrinopathic pigmentation?

Answer 8

Oversecretion of adrenocorticotropic hormone (ACTH) leading to hyperpigmentation in conditions like Addison’s disease.

Question 9

What are the clinical features of smoker’s melanosis?

Answer 9

Diffuse melanotic macules on buccal mucosa, lateral borders of the tongue, palate, and floor of the mouth in cigarette smokers.

Question 10

What are nevi and how are they classified?

Answer 10

Benign proliferation of melanocytes. Classified into nevocellular and blue nevi.

Question 11

What drugs can induce oral mucosal pigmentation?

Answer 11

Minocycline and oral contraceptives are commonly associated with hyperpigmentation.

Question 12

What are the features of HIV oral melanosis?

Answer 12

Diffuse brown macules on the buccal mucosa in HIV seropositive patients.

Question 13

What are melanotic macules?

Answer 13

Small, asymptomatic brown macules on the lips or intraorally on the gingiva, palate, and buccal mucosa.

Question 14

What is malignant melanoma and where is it commonly found in the oral cavity?

Answer 14

A malignant neoplasm of melanocytes. Oral melanomas are rare and typically found on the palate.

Question 15

What are petechiae and ecchymosis?

Answer 15

Petechiae are small pinpoint areas of bleeding in the connective tissue. Ecchymosis is a larger macular discoloration resulting from bleeding.

Question 16

What is hemochromatosis and its oral manifestations?

Answer 16

A hereditary disease causing excess iron deposition in various tissues. Oral manifestations include brown to gray diffuse macules on the palate and gingiva.

Question 17

What is hemangioma?

Answer 17

A developmental enlargement consisting of blood vessels. Color varies from reddish blue to deep blue depending on depth. Commonly found on the tongue and labial mucosa.

Question 18

What is hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)?

Answer 18

A genetic condition characterized by multiple red to purple mucocutaneous macules and nodules due to endothelial discontinuity and lack of elastin.

Question 19

What are varices and where are they commonly found?

Answer 19

Pathologic dilatations of veins, commonly found on the ventral surface of the tongue in the elderly.

Question 20

What is hairy tongue and its management?

Answer 20

Condition characterized by elongation of filiform papillae, retaining bacteria and debris. Management includes cleaning the tongue, using keratolytic agents, and applying antifungal agents if necessary.

Question 21

What causes heavy metal toxicosis and its oral manifestations?

Answer 21

Occupational exposure or therapeutic use of metals like arsenic, lead, mercury, silver, and gold. Oral manifestations include metallic taste, pigmentation, increased salivary secretion, and sore tongue.

Question 22

What is an amalgam tattoo?

Answer 22

The most common source of focal pigmentation in the oral mucosa, appearing as focal bluish gray or black macules adjacent to large amalgam restorations.

Question 23

What is a graphite tattoo and how does it occur?

Answer 23

Traumatic implantation of graphite from a lead pencil, typically occurring on the palate. Appears as focal gray or black macules.

Question 24

What is the role of genetic factors in oral pigmentation?

Answer 24

Genetic factors can play a significant role in oral pigmentation, leading to conditions such as Peutz-Jeghers syndrome and familial melanotic macules.

Question 25

What are oral melanotic macules, and how are they diagnosed?

Answer 25

Oral melanotic macules are small, flat, brown or black lesions on the oral mucosa. Diagnosis is usually clinical, but biopsy may be performed to rule out malignant conditions.

Question 26

What are the differential diagnoses for pigmented lesions in the oral cavity?

Answer 26

Differential diagnoses include amalgam tattoos, melanotic macules, nevi, malignant melanoma, Kaposi’s sarcoma, and pigmented lichen planus.

Question 27

How is oral melanoma managed?

Answer 27

Management includes surgical excision with clear margins, possible lymph node dissection, and close follow-up. Radiation therapy and chemotherapy may be considered in advanced cases.

Question 28

What are the clinical features of Addison’s disease-related oral pigmentation?

Answer 28

Diffuse brownish pigmentation of the oral mucosa, particularly the gingiva, buccal mucosa, and lips, due to increased production of melanocyte-stimulating hormone (MSH) secondary to adrenal insufficiency.

Question 29

What are the clinical implications of post-inflammatory hyperpigmentation in the oral cavity?

Answer 29

Post-inflammatory hyperpigmentation can result from various causes, including trauma, inflammation, and certain medications. It is usually benign but may cause aesthetic concerns.

Question 30

What is the significance of pigmentation in the oral cavity of patients with systemic diseases?

Answer 30

Pigmentation in the oral cavity can be a sign of systemic diseases such as Addison’s disease, Peutz-Jeghers syndrome, and neurofibromatosis, and requires thorough evaluation and management.

Question 31

What are the clinical and histopathological features of blue nevi in the oral cavity?

Answer 31

Clinically, blue nevi present as blue or black macules or papules. Histopathologically, they consist of spindle-shaped melanocytes located in the dermis.