1
Q
Oral Melanosis occurs due to?
A
- Increase in Melanin Production
- Ephelis
- Actinic Lentigo
- Melasma
- Increase in Melanocytes
- Lentigo Simplex
- Melanocytic Nevus
- Melanoma
2
Q
Physiological Pigmentation
A
- AKA Racial Pigmentation
- Appear at birth
3
Q
Smoker’s Melanosis
A
- Melanin produced protective layer
- most common in anterior gingiva
- Most significant change during 1st year of smoking
- correlates to number of cigarettes per day
4
Q
Inflammatory Pigmentation
A
- change in mucosal color due to inflammation
- example:
- Lichen Planus→ Wickman’s Striations
- post tx melanosis occurs
5
Q
Oral Melanotic Macule
A
- Focal Increase of Melanin & melanocytes
- not radiation or sun
- flat, brown
- Avg age=43
- females
6
Q
Melanocanthoma
A
- Melanocyte dendrites spread throughout epithelium
- reaction→trauma
- Solitary (mostly)
- Benign
- AA F
- Biopsy to rule out melanoma
Pic-2 months dramatic enlargement
7
Q
Acquired Melanocytic Nevus
A
- The COMMON MOLE; nevocellular nevus
- congenital or developmental malformation of the skin & mucosa
- BRAF mutation
- Evolutionary development of nevus:
- Junctional
- brown/black macule
- < 6mm
- dark distinct borders
- Compound
- Soft Papule
- slight elevation
- smooth surface
- Pigmentation starts to fade
- Intradermal:
- less pigmentation
- Papillomatous surface
- Hairy center
- Junctional
8
Q
Intraoral Melanocytic Nevus
A
- Uncommon
- Locations:
- Palate
- Mucobuccal fold
- Gingiva
- ⅔ in females
- avg ag=35
- DDX w/condyloma Acuminatum
9
Q
What are the variants of Melanocytic Nevus?
A
- Congenital
- Halo
- Spitz
- Blue Nevus
10
Q
Congenital Melanocytic Nevus
A
- extends deeper into CT
- intermingle w/collagen, adnexal, & neurovascular bundles
- NRAS mutation
- Trunk & extremities
- Manifestations:
- Giant Hair Nevus
- hypertrichosis (Xs hairgrowth anywhere on body)
- Garment Nevus/Bathing Trunk
- large infected area
- looks like pt is wearing a piece of clothing
- Giant Hair Nevus
- At risk for neurocutaneous Melanosis/Melanoma
- =Congenital Nevus + Melanotic neoplasm of CNS
11
Q
Halo Nevus
A
- Melanocytic Nevus w/hypopigmented border
- Immune system destroys melanocytes
- seen w/recent melanoma excision
12
Q
Spitz Nevus
A
- Melanocytic Nevus Variant
- HRAS mutation
- Histology and manifestations similar to melanoma
- Difference=this happens in young people
- Kamino bodies present
- eosinophilic globules in epidermis
13
Q
Blue Nevus
A
- Melanocytes Deep within CT
- found on dorsa of hands, feet, scalp, face & mucosal sites
- Palate-always
- Blue color→Tyndall Effect
- 2 types:
- Common
- Cellular
- associated w/overlying melanocytic nevus
- the two together=Combined Nevus
14
Q
Melanotic Neuroectodermal Tumor of Infancy
A
- Rare, benign, pigmented lesion
- Normally in 1st year of life
- Maxilla (69%)
- Males
- Bone involvement→Sunburst pattern
- looks like osteosarcoma
- Bone destroyed
- Developing Teeth displaced
- Lab:
- High Urinary levels of VMA
- return to normal once tumors is removed
- High Urinary levels of VMA
- Biphasic population of cells that form nests, tubules, or alveolar structures in dense collagenous storm
15
Q
Melanoma: Characterize
A
- Malignant neoplasm from melanocytes
- Genetic alterations in:
- Ras/Raf/MEK/MAPK
- PI3K/AKL
- Risk Factors:
- UV radiation
- High Risk: CDK2A & CDK4
- Moderate to High Risk: MC1R
- 50% have BRAF gene mutation
- if mucosal= KIT gene mutation
- impacts tyrosine kinase receptor RAS interaction
*
16
Q
Melanoma Types:
A
- Superficial Spreading
- most common
- females: Behind the knees
- Males: interscapular area
- Nodular
- sometimes amelonotic
- Lentigo maligna
- from Hutchinson Freckles
- Acral Lentiginous
- most common oral melanoma
- most common in AA
17
Q
Melanoma: Grading System
A
- ABCDE
- Asymmetric
- Border Irregularity
- Color Variation
- Diameter< 6mm
- Evolving
18
Q
Melanoma: Clarks Classification
A
- Level→depth in tissue
- Stage 0
- epidermis
- Stage 1:
- ⅓ of Dermis
- Stage 2:
- ½ of Dermis
- Stage 3:
- All dermis; no fat
- Stage 4:
- Subcutaneous fat
19
Q
Oral Melanoma:
A
- Poor Prognosis if deeper than 0.05mm
- Cutaneous Melanoma= 92% survival rate
- Underlying Bone has moth eaten pattern
- painless ulceration
20
Q
Incontinenia Pigmenti
A
- Rare X-linked dominant Gene
- Xq28 locus, NEMO gene
- Female
- Abnormal skin, eye, teeth, CNS
- 4 stages:
- Vesicular
- skin on trunk & limbs
- Verrucous
- cutaneous plaques on limbs
- Hyperpigmentation
- Atrophy/Depigmentation
- Vesicular
- Oral Manifestation:
- Oligodontia (hypodontia)→most cases
- delayed eruption of primary & secondary teeth
21
Q
Peutz-Jeghers Syndrome
A
- Freckles on hands, perioral skin, & oral mucosa
- AND intestinal polyps
- Autosomal dominant
- STK11 on chromosome 19
- resembles freckles, but dont wax and wane w/sun
- lesions involve periorificial areas
- mouth
- nose
- anus
- genital
- Risk for developing:
- GI adenocarcinoma
- Pancreatic cancer
- M/F genital cancer
- Breast cancer (50% by 60 y.o.)
- Oral Manifestations:
- blue-gray papulles on vermilion zone, buccal mucosa, or tongue
22
Q
Amalgam Tattoo
A
- AKA Focal Argyrosis
- Dropped amalgam on tissues
- Biopsy/remove if:
- mimics mucosal melanoma
- cannot rule out foreign body on radiograph
23
Q
Plumbism
A
- AKA Lead Poisoning
- tx:
- eliminate exposure
- anti-chelating agents
- Burton’s line
24
Q
Argyria
A
- AKA Silver Poisoning
- First signs are in the oral cavity
- Bluish-silver line along the gums
- Tx:
- eliminate exposure
- anti-chelating agent
25
Mercury Poisoning
* Oral Problems:
* Bone loss
* Inflamed mouth
* Gums:
* ulcerated
* darkening
* bleeding
* metal taste
* Digestive Problems:
* Cramps
* inflamed colon
* diarrhea
