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oral Pigmentations

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Naveed Iqbal

Oral pigmentation can be caused by exogenous or endogenous factors. Exogenous factors include black hairy tongue caused by overgrowth of pigment-producing bacteria on the tongue, and amalgam tattoo caused by fragments of dental amalgam becoming embedded in the oral mucosa. Endogenous pigmentation can be due to racial pigmentation which is common in blacks and Asians, pigmented nevi which are benign lesions that should be biopsied, or conditions like Peutz-Jeghers syndrome, Addison's disease, and malignant melanoma. Melanoma is a rare but dangerous oral cancer that requires wide local excision and neck dissection followed by chemotherapy or radiation.

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Dr. Naveed Iqbal
Causes of oral pigmentation ? Exogenous Black hairy tongue Amalgam tattoo ? Endogenous (melanin) Racial pigmentation Pigmented nevi Peutz jeghers syndrome Addison disease Pulmonary diseases HIV infection Lichen planus Oral melanotic macule Malignant melanoma
Exogenous pigmentation ? Black hairy tongue: Hyperplasia of filiform papillae and overgrowth of pigment producing bacteria. Smoking, antibiotic therapy, excessive use of antiseptic mouthwash can be predisposing factors. Treatment is difficult. Instruct the patient to clean and scrap the tongue with tooth brush.
Black Hairy tongue
Amalgam Tattoo ? Fragments of amalgam filling frequently become embedded in oral mucosa through a wound. ? Appear as blue black macules usually on buccal mandibular gingiva. ? May appear radiopaque on radiograph. ? Excision is necessary to exclude melanoma.
Amalgam Tattoo
Endogenous Pigmentation
Racial Pigmentation ? Most common cause of brown oral pigmentation is ethnic ? It occurs in blacks and asians. ? It usually seen on anterior gingiva and palate. ? No treatment is required.
Racial Pigmentation
Pigmented nevi Pigmented nevi are benign lesions of melanocytes which form brown to black macules. They are asymptomatic but should be excised and sent for biopsy to exclude early melanoma.
Pigmented Nevi
Peutz Jeghers Syndrome ? Heritable disease characterized by multiple mucocutaneous pigmented macules and hamartomatous intestinal polyposis. ? Risk of colon, breast and gynecological cancer is high.
Peutz Jeghers Syndrome
Addison disease ? This disease results from atrophy of adrenal cortex and failure of secretion of cortisol and aldosterone. ? Brown to black melanin pigmentation can be seen on buccal mucosa, gingiva, and lips. ? Long term steroid therapy is required.
Malignant melanoma ? It is a malignant neoplasm of melanocyte can occur on skin or mucosal surfaces ? Oral melanoma is rare but have poor prognosis. ? It appear as brown or black macule which grow rapidly and become nodular and ulcerative. ? Metastasis can occur to lymph node, lungs, liver, brain and bones. ? Lesion should be surgically excised with 2 to 5 cm margins and neck dissection followed by radio and /or chemotherapy.
Melanoma

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oral Pigmentations

  • 2. Causes of oral pigmentation ? Exogenous Black hairy tongue Amalgam tattoo ? Endogenous (melanin) Racial pigmentation Pigmented nevi Peutz jeghers syndrome Addison disease Pulmonary diseases HIV infection Lichen planus Oral melanotic macule Malignant melanoma
  • 3. Exogenous pigmentation ? Black hairy tongue: Hyperplasia of filiform papillae and overgrowth of pigment producing bacteria. Smoking, antibiotic therapy, excessive use of antiseptic mouthwash can be predisposing factors. Treatment is difficult. Instruct the patient to clean and scrap the tongue with tooth brush.
  • 5. Amalgam Tattoo ? Fragments of amalgam filling frequently become embedded in oral mucosa through a wound. ? Appear as blue black macules usually on buccal mandibular gingiva. ? May appear radiopaque on radiograph. ? Excision is necessary to exclude melanoma.
  • 8. Racial Pigmentation ? Most common cause of brown oral pigmentation is ethnic ? It occurs in blacks and asians. ? It usually seen on anterior gingiva and palate. ? No treatment is required.
  • 10. Pigmented nevi Pigmented nevi are benign lesions of melanocytes which form brown to black macules. They are asymptomatic but should be excised and sent for biopsy to exclude early melanoma.
  • 12. Peutz Jeghers Syndrome ? Heritable disease characterized by multiple mucocutaneous pigmented macules and hamartomatous intestinal polyposis. ? Risk of colon, breast and gynecological cancer is high.
  • 14. Addison disease ? This disease results from atrophy of adrenal cortex and failure of secretion of cortisol and aldosterone. ? Brown to black melanin pigmentation can be seen on buccal mucosa, gingiva, and lips. ? Long term steroid therapy is required.
  • 15. Malignant melanoma ? It is a malignant neoplasm of melanocyte can occur on skin or mucosal surfaces ? Oral melanoma is rare but have poor prognosis. ? It appear as brown or black macule which grow rapidly and become nodular and ulcerative. ? Metastasis can occur to lymph node, lungs, liver, brain and bones. ? Lesion should be surgically excised with 2 to 5 cm margins and neck dissection followed by radio and /or chemotherapy.