5- pigmented lesions

2 categories of pigmented lesions

1. non-melanin associated

2. melanin-associated

2 types of non-melanin associated pigmented lesions

1. exogenous:

   1. amalgam tattoo (focal argyrosis)

   2. graphite + other foreign body tattoos

   3. med-induced pigmentation

2. endogenous

   1. hemosiderin

   2. bilirubin

2 clinical features of amalgam tattoo (focal argyrosis)

1. blue-gray macule

2. asymptomatic, localized

3 regions commonly affected by amalgam tattoo (focal argyrosis)

1. gingiva/alveolar ridge mucosa (50%)

2. buccal mucosa

3. floor of mouth

T/F: you can see amalgam tattoo (focal argyrosis) radiographically

true

what is this 

graphite tattoo

4 causes of med-induced pigmentation 

1. accumulation of melanin via increase in melanin production or decrease in melanin clearance 

2. accumulation of med

3. synthesis of special pigments 

4. iron deposition

2 clinical features of med-induced pigmentation 

1. diffuse, painless, symmetric bluish-gray macule

2. melanonychia + skin lesions

7 common meds that can cause med-induced pigmentation 

1. minocycline

2. antimalarials

3. clofazamine

4. tranquillizers

5. hormones

6. heavy metals

7. amiodorone

what is this

amalgam tattoo

what is this 

Burton line: indicating heavy metal toxicity

7 types of melanin-associated pigmented lesions 

1. developmental 

2. reactive/inflammatory 

3. infectious 

4. autoimmune + immune mediated 

5. metabolic/systemic

6. neoplastic

7. premalignant/malignant 

melanocytes are developed from which cells

neural crest cells

2 types of developmental melanin-associated pigmented lesions

1. physiological (racial) pigmentation

2. ephelides (freckles)

ephelides (freckles) affects men or women more 

women 

3 types of reactive/inflammatory melanin pigmented lesions

1. oral melanotic macule

2. post-inflammatory hypermelanosis (Smoker’s melanosis)

3. melanoacanthosis

oral melanotic macule affects men or women more

women

oral melanotic macule is usually on which areas

1. lip mucosa

2. gingival mucosa

3. palatal mucosa

4. buccal mucosa

which of the 3 reactive/inflammatory melanin pigmented lesions progress

melanoacanthosis, must be biopsied to rule out melanoma 

post-inflammatory hypermelanosis (Smoker’s melanosis) usually affects which area 

facial gingiva 

differentiate between melanotic macule vs. post-inflammatory hypermelanosis (Smoker’s melanosis)

post-inflammatory hypermelanosis (Smoker’s melanosis) lesions are more diffused 

melanoacanthosis affects men or women more

women, specifically African-American

7 types of developmental melanin pigmented lesions

1. McCune Albright Syndrome

2. Neurofibromatosis I

3. Carney Complex

4. Peutz-Jeghers Syndrome

5. Leopard Syndrome

6. Dyskeratosis Congenita

7. Laugier Hunziker Syndrome

McCune Albright Syndrome is a result of what mutation

GNAS1 mutation

3 clinical features of McCune Albright Syndrome

1. cutaneous hyperpigmentation: café au lait macules

2. polyostotic fibrous dysplasia 

3. endocrine dysfunction: hyperthyroidism, sexual precocity 

neurofibromatosis I is caused by which mutation 

NF1 mutation, autosomal dominant

6 clinical features of neurofibromatosis I

1. café au lait macules

2. axilla freckling

3. cutaneous neurofibroma

4. lische nodules

5. optic glioma

6. plexiform tumor

differentiate between the café au lait macules of McCune-Albright syndrome vs. neurofibromatosis 

• McCune-Albright syndrome: irregular margins

• neurofibromatosis: smooth margins 

Carney complex is caused by which mutation

PRKAR1A gene, autosomal dominant

4 clinical features of the Carney complex

1. cardiac myxomas

2. cutaneous myxomas

3. spotty pigmentation: lentigines on face + lip vermillion border, blue nevi

4. endocrine disease/tumor

Peuts-Jegher syndrome is caused by what mutation

STK11/LKB1 gene, autosomal dominant

2 clinical features of Peuts-Jegher syndrome

1. Freckle-like lesions of the hands, peri-oral region, and/or oral mucosa

2. Intestinal polyposis w/ predisposition to adenocarcinoma

LEOPARD syndrome is caused by which mutation 

PTPN11 gene

7 clinical features of LEOPARD syndrome

1. Lentigines

2. ECG conduction abnormalities

3. Ocular hypertelorism

4. Pulmonic stenosis

5. Abnormal genitalia

6. Retardation of growth

7. Deafness

dyskeratosis congenita is caused by which mutation 

DKC1 gene

3 clinical features of dyskeratosis congenita

1. nail dystrophy 

2. mucosal leukoplakia 

3. hyperpigmentation 

2 clinical features of Laugier-Hunziker Syndrome

1. macules of the labial and/or buccal mucosa

2. longitudinal streaks in fingernails (melanonychia

what’s the autoimmune syndrome that produces melanin pigmented lesions

Addison disease: hypoadrenocorticism

4 clinical features of Addison disease 

1. bronze pigmentation of skin 

2. insufficient production of adrenal corticosteroids 

3. weight loss 

4. postural hypotension 

what is this

melasma: mask of pregnancy

2 types of neoplastic melanin pigmented lesions

1. melanotic neuroectodermal tumor of infancy

2. oral melanocytic nevus

4 clinical signs of melanotic neuroectodermal tumor of infancy

1. 90% in the head + neck within the first 6 months

2. 60% on the palatal mucosa

3. brownish-red mass of alveolar mucosa

4. high levels of vanillylmandelic acid in urine

melanotic neuroectodermal tumor of infancy affects men or women more

men

3 tx options for melanotic neuroectodermal tumor of infancy

1. surgical resection

2. radiation

3. chemo

what type of nevi is the most common

intramucosal

oral melanocytic nevus is benign or malignant

benign

T/F: oral melanocytic nevus can be acquired or congenital

true

what age of ppl get oral melanocytic nevus

20s-40s

5 areas affected by oral melanocytic nevus

1. Hard Palatal Mucosa (44%)

2. Buccal Mucosa (22%)

3. Vermilion Border (18%)

4. Gingiva (12%)

5. Retromolar Pad (4%)

which are more common: macules or nevi

macules

4 types of cutaneous melanoma

1. Superficial spreading melanoma

2. Lentigo maligna melanoma

3. Acral lentiginous melanoma

4. Nodular melanoma

oral melanomas are most prevalent in which ethnicity 

African Americans + Japanese

oral melanomas affect men or women more

men

which 2 areas are most commonly affected by oral melanoma (>70%) 

palatal mucosa + max gingiva 

T/F: all oral melanomas are black in color

false

which area is most commonly affected by head + neck melanoma 

nasal cavity 

2 tx options for oral melanoma

1. excision

2. radiation

what’s the survival rate for oral melanoma 

5 year survival = 10-20% 

T/F: oral melanoma has a 50% recurrence rate

true

Melanomas are a type of cancer that occurs in both the skin and oral mucosa. It however occurs far less commonly intraorally and the palate and gingiva are high risk sites.

• A. Both statements are true

• B. Both statements are false

• C. First true, second false

• D. First false, second true

A. Both statements are true

Which of the following cutaneous melanoma is found more commonly in the oral cavity?

a) Superficial Spreading Melanoma

b) Acral Lentiginous Melanoma

c) Nodular Melanoma

d) Metastatic Melanoma

e) Lentigo Maligna Melanoma

b) Acral Lentiginous Melanoma