Orofacial Pigmentation

Question 1

Oral mucosa

Answer 1

Mucous membrane which lines the inside of the mouth

Question 2

Oral mucosa epithelium

Answer 2

SSE
Underlying ct -lamina propria

Question 3

Pigmentation

Answer 3

Common
Harmless
white patches of skin become darker in colour than surrounding skin

Question 4

pathology of pigmentation

Answer 4

Two things:
1. abnormally high conc of melanocytes producing melanin
2. hyperactive melanocytes

Question 5

ABCDE for identifying skin lesions associated with malignant melanoma

Answer 5

Asymmetry
Border irregularity
Colour variation across the lesion
Diameter of the lesion > 6mm
Evolution - rapid changes occurring in the lesion

Question 6

causes of pigmentation

Answer 6

1. Inherited (physiological)
2. Acquired (local causes - medication) (systemic causes - malignancy)

Question 7

physiological pigmentation

Answer 7

multifocal pigmentation
african/asian heritage
all ages
M:F
Brown/Dark patches
Symmetrical distribution
anterior labial mucosa/palatal mucosa
homogenous in appearance
diagnosis is clinical
biopsy required
no tx

Question 8

Melasma (Cholasma)

Answer 8

Chronic skin disorder causing facial pigmentation
Macules or flat brown patches
F>M
Overproduction of melanin
Triggers (exposure to sun)
Tx (managed by underlying cause Tx. Topical agents prevent new pigment formation)

Question 9

Foreign Body Tattoos

Answer 9

Introduction of coloured foreign material into soft tissues
Amalgam tattoos
Solitary asymptomatic
Mandibular gingivae or alveolar ridge, palate, buccal mucosa

Question 10

Ethnobotanical tattooing

Answer 10

Traditional gingival tattooing
Aesthetic appeal

Question 11

Black hairy tongue

Answer 11

Benign
Brown black coating on dorsal surface
Conservative tx

Question 12

Melanotic macule

Answer 12

Solitary lesion
Increase in melanin deposition
<1cm
1:1000 adults
M:F
Lower lip, ant gingivae, buccal mucosa

Question 13

Vascular malformation

Answer 13

Tongue, lips, buccal mucosa
Well circumscribed flat or raised blue coloured lesions
Diascopy to check whether lesions are vascular
TX- surgically excised/cryotherapy/sclerosing agents

Question 14

Smokers melanosis

Answer 14

Contents of tobacco thought to stimulate melanin production
diffuse pigmentation affecting anterior labial mucosa, palate and buccal mucosa
clinical diagnosis

Question 15

Post inflammatory pigmentation

Answer 15

Melanin hyperpigmentation
chronically inflamed oral mucosa
a-MSH by oral melanocytes
Manifests as a single or multiple brown-black patches, which may persist for a long time after the resolution of the inflammatory process

Question 16

Medication caused pigmentation

Answer 16

Stimulation of melanin production by melanocytes
Palate, buccal mucosa, gingivae
Clinical diagnosis
Discontinuation in medication sometimes tx

Question 17

Systemic cause of pigmentation [Peutz-Jegjhers]

Answer 17

Autosomal dominant condition
Numerous pigmented lesions on lips, buccal mucosa, palms and soles
Intestinal polyps
Increased risk of gastrointestinal malignancy

Question 18

Systemic cause of pigmentation [Thrombocytopenia]

Answer 18

Reduction in number of circulating platelets (inc production of platelets/inc destruction/splenic sequestration)
Petechiae and purpura of mucosa, tendency to bruise, spontaneous bleeding, epistaxis, melena, hematuria
diagnosed on blood count and film
identification and correction of underlying cause

Question 19

Systemic cause of pigmentation [Sturge-Weber Syndrome]

Answer 19

Angiomatous defects associated with the distribution of one or more branches of the trigeminal nerve
Port wine stain appearance of the skin of the face
Contralateral hemiplegia, epilepsy
I/O gingiva and soft tissues affected region may appear blue and swollen
Risk of bleeding

Question 20

Systemic cause of pigmentation [heriditary hemorrhagic telangiectasia]

Answer 20

rare, autosomal dominant
dilatation of terminal blood vessels of skin and mucous membranes
bleeding is frequent
diagnosis on clinical and familial findings
tx based on symptoms

Question 21

Systemic cause of pigmentation [Endocrinopathy]

Answer 21

Addison’s disease
- rare
- destruction of adrenal cortex due to infection/autoimmune/malignant infiltration

Question 22

Addison’s disease

Answer 22

Insidious presentation
Lethargy
Depression
Anorexia
Weight loss
Postural hypotension

Question 23

Malignant Melanoma

Answer 23

Malignant neoplasm of melanocytes
Uncommon - 1.6%
Middle aged males
M>F
I/O arise de novo
asymptomatic
palate/maxillary gingivae
mandible/tongue/buccal mucosa

Question 24

Management of Malignant Melanoma

Answer 24

Surgical excision
Adjunctive therapy