This document discusses various causes of oral pigmentation, including physiologic pigmentation, smoking-associated melanosis, oral melanotic macules, café-au-lait macules, pigmented neuroectodermal tumor of infancy, nevomelanocytic lesions, melanoma, amalgam tattoo, drug-induced pigmentation, and heavy metal pigmentation. It provides details on the clinical features, histopathology, etiology, and treatment of each condition.

1. :Done by
Yousef alothman
Abdullah alsaad
Faheed al zoabi

3. Melanocytes have their embryologic orgin in the neural
crest.
It is migrate and reside among basal cells .
Melanocytes are found in oral mucosa but go to
unnoticed.
When focally or generally active in proliferation or
production, they produce physiologic pigmentation or can
go to malignant neoplasia.
Oral melanin range pigmentation from brown to black to
blue, depending on amount of melanin produced & depth
of pigment.

4. Physiologic
Smoking-associated melanosis
Oral melanotic macules
Café-au-lait macules
Pigmented neuroectodermal tumor of infancy
Nevomelanocytic
Melanoma

5.  Clinical
features:
It is symmetric, persistent & does not alter normal
architecture.
o Can be seen at any age.
o No gender predilection.
o Any location (most common in gingiva).
o Post-inflammatory pigmentation seen after mucosal
reaction to injury.
o

6.  Histopathology:
The lesion is due not to increased numbers of melanocyte
but to increased melanin production.

7.  Etiology & Pathogenesis:
o The lesion is related to a component
stimulate melanocytes
o Female sex hormone (as modifiers)
in tobacco smoke that
 Clinical features:
o Anterior labial gingiva (most commonly affected )
o Palate and buccal mucosa (associated with pipe smoking)
 Histopathology:
o increased melanin production Similar to that seen in
physiologic pigmentation.
 Treatment: stop of smoking (takes months to years)

9.  It
is a focal pigmented lesion that may represent:
1.
2.
3.
Intraoral freckle
Postinflammatory pigmentation
Associated with Peutz-Jeghers syndrome or Addison’s
disease .

10.  Clinical
o
o
o
o
o
features:
It is a benign neoplasm composed of primitive pigment
producing cells (neural crest origin)
Found in infant
Occcurs mainly in the maxilla
Nonulcerated & darkely pigmented mass
Radiographs shows an-ill defined lucency
 Histopathology:
It is composed of nests of tumor cells with small amount of
connective tissue.
 Treatment:
Surgical excision

11.  Nevus is general term that may refer to any congenetal
lesion of various cell types or tissue types.
 Nevomelanocytic Nevi are collection of nevus cells that are
round or polygonal and typically seen in a nested pattern. Can
be found in epithelium, connective tissue, or both.
 Clinical features:
o
o
They appear shortly after birth & throughout childhood.
Intraoral nevi are rare lesions (<0.5 cm-palate).

12.  Histopathology:
o When cells are located in epithelium-connective tissue
junction called Junctional nevus
o When cells are located in connective tissue called
Intramucosal nevus
o When cells are located in combination of zone called
Compound nevus
o When cells are spindle shaped and found deep in connective
tissue called Blue nevus

13. White are more affected than blacks
 Predisposing factors:
o Skin exposure
o Dark nature pigmentation
o Nevi
 Clinical features:
o No sex predilection
o Palate and gingiva are most commonly affected
o Irregular margin

14.  Treatment
o
o
o
o
& prognosis
Surgery
Chemotherapy
Immunotherapy is occasionally used
Prognosis depends on the depth of the lesion

15.  Amalgam tattoo
 Drug induced pigmentation
 Heavy metal pigmentation

16.  Etiology:
 It is an iatrogenic lesion that follows traumatic soft tissue
implantation of amalgam particles.
 Clinical features:
 Most common affected site are:
gingiva, buccal mucosa, palate & tongue
 Histopathology:
 Amalgam particles have an affinity for collagen fibers.

17. Tetracycline-associated pigmentation may be found in
prolonged treatment with high dose.
Other drugs that may produce pigmentation of oral
tissue include amino-quinolines, cyclophosphamide,
amiodarone & AZT.

18. Etiology:
Some heavy metal (lead & mercury) may be
responsible for oral pigmentation
Clinical features:
deposited of heavy metal in the skin & oral mucosa
given color black to gray.

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