Pigmented lesions of the oral mucosa

PIGMENTED
LESIONS OF THE
ORAL MUCOSA
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

Oral and perioral pigmentation may be physiologic
or pathologic in origin. Physiologic pigmentation is
typically brown in appearance. However, in the
course of disease, the oral mucosa and perioral
tissues can assume a variety of discolorations,
including brown, blue, gray, and black. Such color
changes are often attributed to the deposition,
production, or increased accumulation of various
endogenous and exogenous pigmented
substances.

Hemoglobin, hemosiderin, and melanin represent
the most common endogenous sources of
mucosal color change. A sub mucosal collection
of hemoglobin or hemosiderin, produced by lysis
of red blood cells, may impart a red, blue, or
brown appearance. In contrast, melanin, which is
synthesized by melanocytes, may appear brown,
blue, or black, and is often dependant on the
amount of melanin and it’s location within the
tissue.

Pigmented lesions that are of exogenous origin
may usually traumatically deposited directly into
the sub mucosal tissues. In some cases, the
substances may be ingested, absorbed, and
distributed hematogenously, to be precipitated
in the connective tissues, particularly in areas
subject to chronic inflammation, such as the
gingiva. In other instances, these ingested
substances can actually stimulate melanin
production, thus precipitating the color change.

ENDOGENOUS PIGMENTATION
Melanin is found universally in nature. Melanin is
the pigment derative of tyrosine and is
synthesized by melanocytes, which typically
reside in basal cell layer of the epithelium. Their
presence in the skin is thought to protect
against the damaging effects of actinic ir-
radiations as well as to act as scavengers in
protecting against various cytotoxic
intermediates.

Melanin is synthesized within specialized
structures known as melanosomes. Melanin is
actually composed of Eumelanin, which is
brown-black pigment, and pheomelanin, which
has red-yellow color. Melanin pigmentation
maybe physiologic or pathologic and focal
multifocal of diffuse in its presentation. The term
melanosis is frequently used to describe diffuse
hyperpigmentation.

Over production of melanin maybe caused by a
variety of mechanisms, the most common of
which is related to increased sun exposure.
However, intraorally, hyper pigmentation is
more commonly a consequence of physiologic
or idiopathic sources, neoplasia, medication or
oral contraceptive use, high concentrations of
pituitary adrinocorticotropic hormone ( ACTH ),
post inflammatory changes, and genetic or auto
immune diseases.

In addition to biopsy and histologic study, various
laboratory and clinical tests, including dioscopy,
radiography and blood tests, maybe necessary for
definitive diagnosis of oral pigmentation. Dermascopy,
also known as epiluminescence microscopy is another
increasing employed clinical test. A more advanced
method makes use of binocular stereo microscopes with
or without the assistance of digital technology and
imaging software. This diagnostic test has been shown
to be effective in discriminating melanocytic from non
melanocytic lesions and benign versus malignent
melanocytic lesions.

FOCAL MELANOCYTIC
PIGMENTATION
 Freckle/ Ephelis
 Oral/ Labial Melanotic Macule
 Oral/ Melanoacanthoma
 Melanocytic Nevus
 Malignant Melanoma

Freckle/ Ephelis
The cutaneous freckle, or ephelis, is a commonly
occuring, asymptomatic, small (1-3 mm), well
circumscribed, tan- or brown- colored macule that
is often seen on the sun exposed regions of the
facial and perioral skin. Most commonly observed
in light skinned individuals and are quite prevalent
in red- or light blond- haired individuals. Although
the pigmentation itself is focal in nature, most
patients have multiple freckles. These are thought
to developmental in origin.

Ephelides are usually more abundant in
number and darker in intensity in childhood
and adolesence. Freckles tend to become
darker periods of prolonged sun exposure
(spring, summer) and less intense during
the autumn and winters. With increase in
age the number and color intensity tends to
diminish.

ORAL/LABIAL MELANOTIC
MACULE
The melanotic macule is a unique, benign,
pigmented lesion that has no known dermal
counterpart. Melanotic macules are the most
common oral lesions of melanocytic origin.
C/F:- females, lower lip and gingiva,
adulthood.Congenital melanotic macules
have also been described occuring in
tongue.Small, circumscribed, oval or
irregular in outline and uniformly pigmented.

Once the lesion reaches a certain size, it
does not tend to enlarge further. Does not
become dark with sun exposure. Usually
does not recur .
Path:- microscopically,

Pigmented lesions of the oral mucosa

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Pigmented lesions of the oral mucosa

Similar to Pigmented lesions of the oral mucosa (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Pigmented lesions of the oral mucosa