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pigmented lesions
1) The document classifies pigmented lesions as either melanotic or non-melanotic and discusses various localized and diffuse melanotic lesions as well as endogenous and exogenous non-melanotic lesions. 2) Specific melanotic lesions mentioned include acanthosis nigricans, café au lait spots associated with neurofibromatosis or polyostotic fibrous dysplasia, and smoker's melanosis. 3) Non-melanotic lesions discussed include those caused by lipopigments like carotene, red blood cells, vascular lesions like hemangiomas, port wine stains, Kaposi's sarcoma, and hereditary hemorrhagic telangiectasia.
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pigmented lesions
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- 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 •
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- 4. Ectodermal alteration e.g.Acanthosis Nigericans Unusual Dermatosis :characterizedby A-hyperkeratosis B-melanin pigmentation C-white oral lesions
- 6. :Types Benign: associated with insulinresistant .diabetes Malignant :internal malignancy release certain peptides ,stimulate melanin .production
- 7. Increased melanin production :Caféau lait spots-1 A-Multiple neurofibromatosis(Von (Recklinhausen disease .B-Polyostotic fibrous dysplasia
- 8. A-multiple neurofibromatosis It isan inherited autosomal dominant neuroectodermal abnormality ,characterized by proliferation of fibrous element of the nerve
- 9. 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
- 10. Neurological manifestation: a-centrally-2 (located lesions (deafness ,pain ,epilepsy b-mandibular nerve involvement appears as R.L area associated with lip numbness
- 11. :Café au laitpigmentation- 3 More than 5mm (prepubertal More than 15 mm in diameter: post pubertal
- 13. B-Polyostotic fibrous dysplasia :Jaffetype-1 unilateral boneinvolvement most bone are intact-Skin café au lait spots no endocrinalinvolvement
- 14. Albright syndrome- 2 AsJaffe but have endocrinal :disturbances parathyroidThyroid Pituitary Gonads (precocious (puberty
- 15. smoker melanosis- 2 Diffusebrown flat macules ,mainly on anterior labial gingiva,in cigarette smokers On the palate in pipe smokers
- 17. Pigmented lichen planus Thisincrease in melanogenesis may be stimulated by the infilterate of TLynphocytes,through the cytokines they produce Rare in erosive or) (papular form
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- 19. Oral melanotic naevi Benignproliferation of melanocytes which form localized brown to black patches)5(6mm
- 20. (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
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- 22. 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 - -
- 25. Peutz- jegher syndrome :Clinicalpicture 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
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- 30. Heamochromatosis Primary :disorder ofnewborn ,due to increased intestinal iron absorption Secoundry: due to increased iron intake, or increased RBCs destruction
- 31. Porphyria Hereditary disease causedby 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
- 33. 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
- 36. Endocrinopathic pigmentation Bronzing ofskin and patchy melanosis of oral mucous membrane due to Pituitary hyperfunction or Addisons disease(increase in ACTH( stimulate melanocytes
- 39. HIV Melanosis Flat ,BrownMacules Mainly on buccal and labial mucosa
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- 41. Lipopigments A-Lipochrome(Carotene(:yellow or redfat 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
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- 45. RBCs pigments Extravasation dueto trauma ,bleeding tendency or blood vessels abnormality First red then turn brown due to hemosidirin
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- 50. Hemangioma Vascular lesions presentingproliferation of vascular channels are tumor like .hamartomas Close to epithelium appear red ,deep appear blue
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- 53. Kaposis sarcoma Rare tumourof vascular origin,accompany HIV infection Sites: head ,neck ,tip of nose ,intra-orally: palate
- 56. Hereditary Hemorrhagic Telangiectasia A Geneticallytransmitted 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
- 58. Varix Pathological dilatation ofveins 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
- 60. Exogenous pigmentation Black hairytongue Tattoo: amalgam ,graphite Metallic intoxification
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Editor's Notes
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