1. Pigmented lesions

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. Localized melanotic lesions-1

4. Ectodermal alteration
e.g.Acanthosis
Nigericans
Unusual Dermatosis
:characterized by
A-hyperkeratosis
B-melanin pigmentation
C-white oral lesions

6. :Types
Benign: associated with
insulin resistant
.diabetes
Malignant :internal
malignancy release
certain peptides
,stimulate melanin
.production

7. Increased melanin production
:Café au lait spots-1
A-Multiple neurofibromatosis(Von
(Recklinhausen disease
.B-Polyostotic fibrous dysplasia

8. A-multiple neurofibromatosis
It is an 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 lait pigmentation- 3
More than 5mm
(prepubertal
More than 15 mm in
diameter: post
pubertal

13. B-Polyostotic fibrous dysplasia
:Jaffe type-1
unilateral boneinvolvement
most bone are intact-Skin café au lait spots
no endocrinalinvolvement

14. Albright syndrome- 2
As Jaffe but have
endocrinal
:disturbances
parathyroidThyroid
Pituitary
Gonads (precocious
(puberty

15. smoker melanosis- 2
Diffuse brown flat
macules ,mainly on
anterior labial
gingiva,in cigarette
smokers
On the palate in pipe
smokers

17. 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

18. Melanocyte proliferation
nevocellular nevi-1
Melanoma-2
Peutz-jegher syndrome- 3

19. Oral melanotic naevi
Benign proliferation 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

21. Junctional
Compound
intradermal
Blue nevus

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
: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

29. Physiologic pigmentation

30. Heamochromatosis
Primary :disorder of newborn ,due to
increased intestinal iron absorption
Secoundry: due to increased iron intake, or
increased RBCs destruction

31. 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

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 of skin and
patchy melanosis of
oral mucous
membrane due to
Pituitary
hyperfunction or
Addisons
disease(increase in
ACTH( stimulate
melanocytes

39. HIV Melanosis
Flat ,Brown Macules
Mainly on buccal and
labial mucosa

40. Non melanotic-2
:A-endogenous
lipopigmentsRBCsVascular lesions-

41. 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

43. B-sebaceous glands

45. RBCs pigments
Extravasation due to trauma ,bleeding
tendency or blood vessels abnormality
First red then turn brown due to hemosidirin

46. Ecchymosis
petechiae

47. Petechiae

48. Jaundice
Hemolytic- 1
hepatocellular-2
Obstructive jaundice-3

50. Hemangioma
Vascular lesions presenting proliferation of
vascular channels are tumor like
.hamartomas
Close to epithelium appear red ,deep appear blue

51. Hemangioma

52. Portewine stain

53. Kaposis sarcoma
Rare tumour of vascular origin,accompany
HIV infection
Sites: head ,neck ,tip of nose ,intra-orally:
palate

56. 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

58. 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

60. Exogenous pigmentation
Black hairy tongue
Tattoo: amalgam ,graphite
Metallic intoxification

61. Black Hairy tongue

62. Amalgam Tattoo

64. Metallic intoxification