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- Chapter 032. Oral Manifestations
of Disease
(Part 4)
Pigmented Lesions
See Table 32-2.
Table 32-2 Pigmented Lesions of the Oral Mucosa
Condition Usual Clinical Course
Location Features
Oral Any area Discrete or Remains
melanotic macule of the mouth diffuse localized, indefinitely; no
- brown to black macule growth
Diffuse Any area Diffuse pale to Remains
melanin of the mouth dark-brown indefinitely
pigmentation pigmentation; may be
physiologic ("racial")
or due to smoking
Nevi Any area Discrete, Remains
of the mouth localized, brown to indefinitely
black pigmentation
Malignant Any area Can be flat and Expands and
melanoma of the mouth diffuse, painless, invades early;
brown to black, or can metastasis leads to
be raised and nodular death
Addison's Any area Blotches or Condition
disease of the mouth, spots of bluish-black to controlled by
but mostly dark-brown adrenal steroid
buccal mucosa pigmentation occurring replacement
- early in the disease,
accompanied by
diffuse pigmentation of
skin; other symptoms
of adrenal
insufficiency
Peutz- Any area Dark-brown Oral
Jeghers syndrome of the mouth spots on lips, buccal pigmented lesions
mucosa, with remain indefinitely;
characteristic gastrointestinal
distribution of pigment polyps may become
around lips, nose, eyes, malignant
and on hands;
concomitant intestinal
polyposis
Drug Any area Brown, black, Gradually
ingestion of the mouth or gray areas of disappears following
(neuroleptics, oral pigmentation cessation of drug
contraceptives,
- minocycline,
zidovudine, quinine
derivatives)
Amalgam Gingiva Small blue- Remains
tattoo and alveolar black pigmented areas indefinitely
mucosa associated with
embedded amalgam
particles in soft tissues;
these may show up on
radiographs as
radiopaque particles in
some cases
Heavy metal Gingival Thin blue-black Indicative of
pigmentation margin pigmented line along systemic absorption;
(bismuth, mercury, gingival margin; rarely no significance for
lead) seen except for oral health
children exposed to
lead-based paint
- Black hairy Dorsum Elongation of Improves
tongue of tongue filiform papillae of within 1–2 weeks
tongue, which become with gentle brushing
stained by coffee, tea, of tongue or
tobacco, or pigmented discontinuation of
bacteria antibiotic if due to
bacterial overgrowth
Fordyce Buccal Numerous small Benign;
"spots" and labial yellowish spots just remains without
mucosa beneath mucosal apparent change
surface; no symptoms;
due to hyperplasia of
sebaceous glands
Kaposi's Palate Red or blue Usually
sarcoma most common, plaques of variable size indicative of HIV
but may occur in and shape; often infection or non-
any other site enlarge, become Hodgkin's
nodular and may lymphoma; rarely
fatal, but may
- ulcerate require treatment for
comfort or cosmesis
Mucous Buccal Bluish-clear Benign;
retention cysts and labial fluid-filled cyst due to painless unless
mucosa extravasated mucous traumatized; may be
from injured minor removed surgically
salivary gland
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