• Ethnic pigmentation and tatoos

• Melanotic macule

• Nevus and others

• Malignant melanoma

Group 2• Son , Sarmiento, Pollio,

Bebida, Ambrad

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 organelles called

melanosomes.

- Melanin is also synthesized by nevus cells, which

are derived from the neural crest and are

found in the skin and mucosa.

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

Hairy tongue - used to describe an abnormalcoating on the top (dorsal) surfaceof the tongue.

- It is a relatively common,temporary, and harmlesscondition that occurs in as much as13% of the population.

- occur at any age but is morefrequent in older age.It mayappear brown, white, green, orpink, depending upon the specificcause and other factors.

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.

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.

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.

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.

• 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.

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)

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.

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

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.

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.

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.

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.

No treatment is

required for oral

melanotic macule

except for esthetic

considerations

Women can use

Lipstick to cover the

Lesion

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.

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.

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.

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

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.

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

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

Melanoma can occur

in adults of any age

but is very rare in

children.

Surgery is the

definitive treatment

for early-stage

melanoma.

Malignant melanoma

o Cancerous, Brown or black skin lesion with irregularities in symmetry, border

Kaposi sarcoma

o Brownish-red to blue

colored skin lesions

Purpura

Desquamative gingivitis

Mucositis

Erythematous candidosis

Chronic candidosis

Angular stomatitis

Median rhomboid glossitis

Angiomas

Red and purple lesions are usually caused by increased vascularity

or extravasation of blood.

Inflammation is the common cause of redness but there are other

causes.

Localized red areas may represent:

Trauma

Erythema migrants

Erythroplasia

Carcinoma

Candidosis

Lichen planus

Lupus

Erythematous

Vascular lesions.

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.

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.

Desquamative gingivitis

o Sore, red glazed, or

red and ulcerated

gingiva.

Psoriasis

o Red, itchy and scaly patches usually in the buccal area

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.

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.

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)

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

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.

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.

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/ pappilaryhyperplasia usually on the central hard palate and alveolar ridge

Also known as

“Angular Chellitis” or

“Perleche”

Angular stomatitis is

an affliction which

mainly affects the

mouth and the lips.

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.

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.

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.

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)

Vascular tumors are neoplasms of the

vasculature.

Vascular malformations represent anomalous

blood vessels without any endothelial

proliferation or cellular turnover.

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.

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

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