The document discusses various types of pigmented and red lesions that can occur in the oral mucosa. It describes physiologic pigmentation that commonly affects different ethnic groups. It also covers amalgum and graphite tattoos which appear as painless blue or gray lesions from introduction of foreign materials. Other benign pigmented lesions mentioned include oral melanotic macule, nevi and ACTH-induced hyperpigmentation. Malignant melanoma, a type of skin cancer, is also discussed. Red lesions can be caused by factors like inflammation, trauma, erythema or vascular abnormalities. Specific conditions covered include desquamative gingivitis, mucositis and erythematous candidiasis.

1. • Ethnic pigmentation and
tatoos
• Melanotic macule
• Nevus and others
• Malignant melanoma
Group 2
• Son , Sarmiento, Pollio,
Bebida, Ambrad

2.  Pigmented lesions of oral mucosa appear blue, brown, or
black.
 They are classified:
1. Generalized lesions, which are diffuse and
multifocal.
2. Localized lesions, which are unilateral and involve
only one or several locations.
 Melanin - Produced by melanocytes in the basal layer of
the epithelium.
- It is trasnsfered to adjacent keratinocytes via
membrane-bound organellescalled
melanosomes.
- Melanin is also synthesized by nevus cells, which
are derived from the neural crest and are
found in the skin and mucosa.

3. Superficial brown discoloration of tongue and teeth which is
easily removed and of little consequence is commonly cause by:
Habits:
• cigarette smoking, tobacco or betel chewing
Beverages:
• coffee, tea and red wine
Foods:
• beet, liquorice
Drugs:
• iron, chlorhexidine, bismuth

5. Hairy tongue - used to describe an abnormal
coating on the top (dorsal) surface
of the tongue.
- It is a relatively common,
temporary, and harmless
condition that occurs in as much as
13% of the population.
- occur at any age but is more
frequent in older age.It may
appear brown, white, green, or
pink, depending upon the specific
cause and other factors.

6. Too much bacteria or yeast growth in the mouth. The
bacteria build up on tiny rounded projections called papillae.
 Instead of shedding as they normally do, the papillae start
to grow and lengthen, creating hair-like projections. They can
grow to 15 times their normal length.The papillae are
pinkish-white. But as they grow, pigments from food, drinks,
and possibly the bacteria or yeast themselves get caught in
the papillae, dyeing the tongue a color.
Black hairy tongue don't have any symptoms or feel any
discomfort.
The exception is when there is too much growth of the yeast
Candida albicans, which can cause a burning sensation on
the tongue.

7. Certain lifestyle habits and conditions can make people
more likely to develop black hairy tongue. They include:
o poor oral hygiene
o smoking tobacco
o drinking a lot of coffee or tea
o using antibiotics (which may disrupt the normal
balance of bacteria in the mouth)
o not producing enough saliva
o regularly using mouthwash
Black hairy tongue is more common in men, people
who use intravenous drugs, and those who are HIV-
positive.

8. Discontinue any responsible drugs, mouthwashes
or habits.
Increase oral hygiene, scape or brush the
tongue in the evenings.
Use sodium bicarbonate, peroxide or 40% urea
in water, chew gum and or suck pineapple or
peach stone.

9. Black hairy tongue
Abnormal coating on the
top surface of the
tongue. Not painful..
Tongue necrosis
Discoloration and swelling
with pain and discomfort of
the anterior half of the
tongue.

11. • Physiologic oral pigmentation manifests as multifocal
or diffuse melanin pigmentation seen mainly in various
ethnic groups.
• Occurs in all races. The intensity and distribution of
racial pigmentation is variable, not only between
races, but also between different individuals of the
same race and within different areas of the same
mouth.

12. Age mainly affected:
• All ages
Gender mainly affected:
• M = F
• The darker a person’s skin color the more likely
they are to have oral pigmentation.
• Genes known to contribute to skin color:
1. MC1R (Melano cortin 1 recepto
2. SLC24A5 (Solute carrier family 24 member 5)

13. History:
 May be first noticed in adult life and then
assumed incorrectly to be acquired rather
than congenital.
Clinical features:
 Brown or blackish patches most obvious in
the anterior labial gingivae.

14. are tattoos caused by the introduction of colored
foreign material.
Example:
An amalgam tattoo is a localized, blue-grey lesion of
variable dimensions most commonly sited on the
gingiva or alveolar mucosa, or less commonly the floor
of mouth or buccal mucosa.
Graphite can be introduced into the oral mucosa
through accidental injury with a graphite pencil. This
lesion is an irregular grey-black maccule, most
commonly on the anterior palate of young children

16. These tattoos are not dangerous and will not cause
you harm.
After the gingiva, the alveolar mucosa and the buccal
mucosa are the next most common sites, although
any mucosal site in the mouth is possible.
 It is painless, and appears as a blue-black or grey
discolored macule on the surface of the mucosa.

17.  Amalgam tattoo can be distinguished from other causes of
localized oral pigmentation because it does not change
significantly in size or color although it may appear to
slowly enlarge for several months after the initial
implantation of the metal particles. Some amalgam tattoos
appear radio-opaque on radiographs.
Use of a dental dam during dental procedures which
involve amalgam should reduce the risk of amalgam tattoo
No treatment is required since the lesion is entirely
benign.

18. Amalgam tattoo
o Painless, not dangerous
and will not cause you
harm. (totally Benign)
Oral melanoma
o Signs are swelling, ulceration,
bleeding, pain/discomfort,
and ill-fitting dentures.

20. This is a benign pigmented lesion commonly sited
on the lower lip.
Usually solitary, a labial melanotic macule is most
commonly seen in adult women but it also occurs in
males and in young people. Occasionally the
lesion can be on the upper lip.
Size ranges from 1 to 8mm. Once developed the
lesions usually remain unchanged in size and
color.

21. No treatment is
required for oral
melanotic macule
except for esthetic
considerations
Women can use
Lipstick to cover the
Lesion

22. Melanotic macule
o It is asymptomatic, flat and not
thickened, and appears similar
to freckle of skin.
Melanoma
o melanoma begins as an
irregular, brown to black
macule, later the lesion will
develop thickening and
sometimes ulceration and
can be malignant.

24. Nevus is a broad term that refers to a number
of different lesions, often present from birth
but can also be acquired. And refers to a
melanin pigmented lesion
Oral nevi are much less common than
cutaneous. It’s formed from increased melanin-
containing cells.

25. Nevi include:
1. Intramucosal nevus(about 60%) -
consists of a collection of melanocytic
cells in lamina propria without
involvement of the epithelium.
2. Blue nevus(25%) - deeply situated
and are composed of spindled cells at
any level in the lamina propria.
 Rare variants include:
1. Junctional - consist of clusters of
benign nevus cells confined to the basal
layer at the epethelial-mesenchymal
junction and the lamina propria is not
involved
2. Compound nevi - epithelium and
corium are involved.

26. o Asymptomatic and unchanging in
character.
o Seen particularly in palate, buccal
mucosa or the vermillion border
of the lip.
o Excision biopsy is recommended;
this is particularly important if the
lesions are raised or nodular

27. ACTH is a hormone produced in the anterior
pituitary gland in the brain. The function of
ACTH in the body is to regulate levels of the
steroid hormone cortisol, released from the
adrenal gland.
Oral and skin hyperpigmentation may be seen
in ACTH.

28. Addison’s disease-
adrenocortical hypofunction which
results in hypotension and
overproduction of ACTH
Nelson syndrome- result from
adrenalectomy in the
management of breast cancer.
Brown or black pigmentation is
typically seen on soft palate,
buccal mucosa and at sites of
trauma.
Hyperpigmentation is most obvious
in areas normally pigmented.
o Areolae of nipples
o Genitalia
o Skin flexures
o Sites of trauma

30. Is a type of cancer that develops from the pigment-
containing cells known as melanocytes.
Typically they occur in the skin but may rarely occur
in the mouth, intestines, or eye.
Risk factors for melanoma include:
Excessive exposure to the sun or tanning booths or
tanning beds, Fair skin, Family members with a
history of melanoma, such as parent, child or sibling,
Freckles, Red or blonde hair, Birth moles, Prior
diagnoses of malignant melanoma, Unusual or many
moles

31. Melanoma can occur
in adults of any age
but is very rare in
children.
Surgery is the
definitive treatment
for early-stage
melanoma.

32. Malignant melanoma
o Cancerous, Brown or
black skin lesion with
irregularities in symmetry,
border
Kaposi sarcoma
o Brownish-red to blue
colored skin lesions

33.  Purpura
 Desquamative gingivitis
 Mucositis
 Erythematous candidosis
 Chronic candidosis
 Angular stomatitis
 Median rhomboid glossitis
 Angiomas

34.  Red and purple lesions are usually caused by increased vascularity
or extravasation of blood.
 Inflammation is the commoncause of redness but there are other
causes.
 Localized red areas may represent:
Trauma
Erythema migrants
Erythroplasia
Carcinoma
Candidosis
Lichen planus
Lupus
Erythematous
Vascular lesions.

35. Ecchymosis and petechiae, due to bruising and
negative pressure are common in the junctional area
of the hard and soft palates; they do not blanch
with pressure because of blood extravasion.
The color can vary from blue, to purple, to red, to
brown.

37.  It is an erythematous (red), desquamatous
(shedding) and ulcerated appearance of the gums.
Gingival erythema blurs the distinction between the
normally colored pink attached gingivae and the
more red vestibular mucosae.
Treatment should be a maintained oral hygiene.

38. Desquamative gingivitis
o Sore, red glazed, or
red and ulcerated
gingiva.
Psoriasis
o Red, itchy and scaly
patches usually in the
buccal area

40.  It is the painful inflammation and
ulceration of the mucous membranes
lining.
 Adverse effect of chemotherapy and
radiotherapy treatment for cancer.
 It can lead to several problems,
including pain, nutritional problems as
a result of inability to eat, and
increased risk of infection due to open
sores in the mucosa.
 Prophylaxis, oral cooling with ice
chips, keratinocytes growth factor and
low-level laser therapy can reduce
chemotherapy-induced mucositis.

42. Is a type of Oral Candidiasis, also
known as “Oral Thrush” in which the
fungus Candida albicans accumulate in
the mouth.
It appears in red, raw-looking lesion.

44. Also termed as: “Antibiotic sore
tongue”, “antibiotic induced
stomatitis”. Usually occurs in the
dorsum of the tongue in taking
long term corticosteroids or
antibiotics.
Adults are mainly affected but
the sex mainly affected are equal
(M=F)

45. Acute candidiasis is best treated with anti fungal
drugs:
Nystatin
Ampho-tericin
Miconazole or fluconazole
Highly Active Antiretoviral Therapy(HAART)
– reduces the frequency of candidiasis in HIV
Infection

47. Complex medical
syndrome attributed to
an overgrowth in the
GI tract of the usually
benign yeast (or
fungus) Candida
albicans.
Usually associated
with denture wearing.

49. A condition is known as “denture sore mouth”,
there is rarely any pain associated.
The term refers to a mild inflammation and
erythema of the mucosa beneath a denture
(usually and upper denture in elderly edentulous
individuals) and usually asymptomatic.
Middle age and older people are mainly
affected and female have the higher risk than
male.

50. Newton divides denture related
stomatitis into three types
based on severity:
 Type 1 – Localized
inflammation and pinpoint
hyperemia
Type 2 – More diffuse
erthema involving part or all
of the mucosa which is
covered by the denture
Type 3 – Inflammatory
nodular/ pappilary
hyperplasia usually on the
central hard palate and
alveolar ridge

52. Also known as
“Angular Chellitis” or
“Perleche”
Angular stomatitis is
an affliction which
mainly affects the
mouth and the lips.

53.  According to the studies, there is no apparent angular stomatitis causes.
However there are certain things that could affect in getting the said
affliction
 Vitamin Deficiency - when we lack certain vitamins, our immune system
would be among the first to be affected. Angular stomatitis would occur if
you lack VITAMIN B12 (COBALAMIN- one of the 8 B vitamins that help
convert food (carb) into fuel (glucose) used to provided energy. B vit often
reffered to as Bcomplex vit are needed for HEALTHY SKIN, HAIR, EYES and
LIVER. Also help nervous system funtion properly).
 Iron Deficiency - if there’s a deficiency in Cobalamin, Iron tends to be
affected for the reason that Vit B12 works woth vit B9 (FOLATE/ FOLOC
ACID) to help make RBC and to help iron work beter in the body. Iron
defficiency can be a warning sign for Angular Cheilitis. (also (Ribiflavin)B2
deficiency)
 Ill-fitted dentures - Dentures should be kept clean and disinfected the whole
time or else, the would serve as breeding grounds for the bacteria.
 Other Factors – would include overexposure to sun, dry mouth and lips and
eating the wrong food.

55. Also called “Central papillary atrophy of the
tongue” or “Glossal central papillary atrophy”.
There is a rhombus-shaped, well-demarcated
and central denuded area of the tongue exhibits
a red to dark pink appearance.
This is often asymptomatic.

56. MRG is not transmitted from
one individual to another;
However Candida can be
transmitted from one person
to another when the
unaffected individual is in a
low resistance state.
Antifungal regimen, including
replacement of toothbrush.
Antifungal that are commonly
used are: Nystatin,
clotrimazole, fluconazole
and ketoconazole.

57. Vascular birthmarks, or congenital vascular
anomalies, are common lesions that may present in
a variety of fashions.
Divided into two main categories
1. Vascular tumor (Capillary, Venous lymphatic ans
arterovenous malformations)
2. Vascular malformations (Hemangioma, kapiso
from hemangioendothelioma and tufted angioma)

58. Vascular tumors are neoplasms of the
vasculature.
Vascular malformations represent anomalous
blood vessels without any endothelial
proliferation or cellular turnover.

60. A reddish, bluish or
purplish soft vascular
lesion which blanches on
pressure and fluctuant to
palpation.
Are level with the mucosa
or have a lobulated or
raised surface
Are at risk from trauma
and prone to excessive
bleeding if damaged.

62.  These re malformations of
the lymphatic system,
characterized by lesions that
are thin-walled cysts.
These are also uncommon,
hamartomatous, congenital
malformations of the
lymphatic system that involve
the skin and subcutaneous
tissues

63. Patients with lymphatic malformations
experience infections, often associated with
significant increase in the size of lession.
Rapid enlargement of lesion may lead to
airway obstruction.
Children with such lesions require tracheostomy