pigmented lesions


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  • pigmented lesions

    1. 1. Pigmented lesions
    2. 2. Classification :melanotic-1 • a-localized • b-diffuse • :Non melanotic-2 • :A-endogenous • Lipopigments • Due to RBCs • Vascular lesions • B-exogenous • Black hairy tongue • Tattoo • Metallic intoxification •
    3. 3. Localized melanotic lesions-1
    4. 4. Ectodermal alteration e.g.Acanthosis Nigericans Unusual Dermatosis :characterized by A-hyperkeratosis B-melanin pigmentation C-white oral lesions
    5. 5. :Types Benign: associated with insulin resistant .diabetes Malignant :internal malignancy release certain peptides ,stimulate melanin .production
    6. 6. Increased melanin production :Café au lait spots-1 A-Multiple neurofibromatosis(Von (Recklinhausen disease .B-Polyostotic fibrous dysplasia
    7. 7. A-multiple neurofibromatosis It is an inherited autosomal dominant neuroectodermal abnormality ,characterized by proliferation of fibrous element of the nerve
    8. 8. Clinical features Multiple nodules: sessile-1 or pedunculated mostly affects the trunk Tongueinvolvement,appears as multiple nodules,due to lingual nerve involvement,scrotal tongue and enlarged .fungiform papillae
    9. 9. Neurological manifestation: a-centrally- 2 (located lesions (deafness ,pain ,epilepsy b-mandibular nerve involvement appears as R.L area associated with lip numbness
    10. 10. :Café au lait pigmentation- 3 More than 5mm (prepubertal More than 15 mm in diameter: post pubertal
    11. 11. B-Polyostotic fibrous dysplasia :Jaffe type-1 unilateral boneinvolvement most bone are intact-Skin café au lait spots no endocrinalinvolvement
    12. 12. Albright syndrome- 2 As Jaffe but have endocrinal :disturbances parathyroidThyroid Pituitary Gonads (precocious (puberty
    13. 13. smoker melanosis- 2 Diffuse brown flat macules ,mainly on anterior labial gingiva,in cigarette smokers On the palate in pipe smokers
    14. 14. Pigmented lichen planus This increase in melanogenesis may be stimulated by the infilterate of TLynphocytes,through the cytokines they produce Rare in erosive or) (papular form
    15. 15. Melanocyte proliferation nevocellular nevi-1 Melanoma-2 Peutz-jegher syndrome- 3
    16. 16. Oral melanotic naevi Benign proliferation of melanocytes which form localized brown to black patches)5(6mm
    17. 17. (junctional nevi :)flat, brown round or oval - 1 Compound nevi: proliferate down to C.T -2 (Dome shaped ,brown lesions) Intradermal/intramucosal: localized in C.T -3 (elevated brown nodules) Blue nevi: nevus reside deeply inside C.T-4
    18. 18. Junctional Compound intradermal Blue nevus
    19. 19. Melanoma/Malignant melanoma .Raised ,painless ,sessile or pedunculated Most commonly found on the palate and .anterior labial gingiva :Malignant transformation Increased pigmentation Bleeding or ulceration - -
    20. 20. Peutz- jegher syndrome :Clinical picture A-brown pigmentation: multiple melanotic (macules )perioral-perinasal-perioccular Hands and feet also affected Facial pigmentation may disappear but intra .oral remain B-Intestinal polyposis
    21. 21. Physiologic pigmentation
    22. 22. Heamochromatosis Primary :disorder of newborn ,due to increased intestinal iron absorption Secoundry: due to increased iron intake, or increased RBCs destruction
    23. 23. Porphyria Hereditary disease caused by abnormalities in heme biosynthesis, results in increased porphyrins :Types cutaneous hepatic porphyria:erythema ,then vesicles ,then-1 form bullae,that heal by scar with skin hyperpigmentation :congenital erythropoeitic porphyria-2 a-Excessive porphyrin in in bone marrow,causes photosensitivity ,then .vesicular eruption b- vesicles contain serous fluid with red fluorescence C-red urine (D-lavender teeth)both decidious and permanent teeth
    24. 24. Pellagra (:It is Niacin (nicotinic acid deficiency Dermatitis with melanin pigmentation of skin -1 Dementia-2 Diarrhea-3 Death-4 :Oral manifestation Stomatitis,glossitis,ANUG,Angular Cheilosis,Herpes labialis,deminution of taste sensation
    25. 25. Endocrinopathic pigmentation Bronzing of skin and patchy melanosis of oral mucous membrane due to Pituitary hyperfunction or Addisons disease(increase in ACTH( stimulate melanocytes
    26. 26. HIV Melanosis Flat ,Brown Macules Mainly on buccal and labial mucosa
    27. 27. Non melanotic-2 :A-endogenous lipopigmentsRBCsVascular lesions-
    28. 28. Lipopigments A-Lipochrome(Carotene(:yellow or red fat soluble pigments found in carrots,tomato ,sweet potato,green leafs . and egg yolk Excessive intake of carotene results in carotenemia Results in yellow color of skin and mucous (membrane ,(no eye involvement
    29. 29. B-sebaceous glands
    30. 30. RBCs pigments Extravasation due to trauma ,bleeding tendency or blood vessels abnormality First red then turn brown due to hemosidirin
    31. 31. Ecchymosis petechiae
    32. 32. Petechiae
    33. 33. Jaundice Hemolytic- 1 hepatocellular-2 Obstructive jaundice-3
    34. 34. Hemangioma Vascular lesions presenting proliferation of vascular channels are tumor like .hamartomas Close to epithelium appear red ,deep appear blue
    35. 35. Hemangioma
    36. 36. Portewine stain
    37. 37. Kaposis sarcoma Rare tumour of vascular origin,accompany HIV infection Sites: head ,neck ,tip of nose ,intra-orally: palate
    38. 38. Hereditary Hemorrhagic Telangiectasia A Genetically transmitted disease ,inherited as an autosomal dominant trait, about 100 purple papule on the vermilion and mucosal surfaces of .the lips and tongue .Also the facial skin and neck are also involved :Differential diagnosis .Petechial hemorrhages with platelet disorders
    39. 39. Varix Pathological dilatation of veins and venules mostly common intra orally in the ventral surface of the tongue appear as tortuous (blue ,red and purple elevation Degenerative change in adventitia of venous .walls as result of aging
    40. 40. Exogenous pigmentation Black hairy tongue Tattoo: amalgam ,graphite Metallic intoxification
    41. 41. Black Hairy tongue
    42. 42. Amalgam Tattoo
    43. 43. Metallic intoxification