Oral Path Exam 2 - Blue, Brown, Gray, and Black Lesions

Question 1

What lesions?

Caused by increase in production of melanin by melanocytes, but there is a normal number of melanocytes

Answer 1

Physiologic (racial) pigmentation
Smoker’s melanosis

Question 2

What lesion?

Found in pts with darker complexion

Answer 2

Physiologic (racial) pigmentation

Question 3

What lesion?

Most common location = attached gingiva

Answer 3

Physiologic (racial) pigmentation

Question 4

What lesion?

Can be seen anywhere, even tips of fungiform papillae on dorsal tongue

Answer 4

Physiologic (racial) pigmentation

Question 5

What lesion?

Diagnosis is established clinically; biopsy is not conclusive w/o clinical correlation

Answer 5

Physiologic (racial) pigmentation

Question 6

What lesions?

No tx necessary

Answer 6

Physiologic (racial) pigmentation
Amalgam tattoo
Drug-related pigmentation
Melanotic macule

Question 7

What lesion?

Caused by autosomal dominant genetic disease

Answer 7

Peutz-Jeghers syndrome

Question 8

What lesion?

Oral and perioral freckles that first present during childhood and adolescence; lips and cheeks

Answer 8

Peutz-Jeghers syndrome

Question 9

What lesion?

Skin and mucosal freckles

Answer 9

Peutz-Jeghers syndrome

Question 10

What lesion?

Multiple GI hamartomatous polyps; do not have same level risk of transformation to colorectal cancer as adenomatous polyps

Answer 10

Peutz-Jeghers syndrome

Question 11

What lesion?

Increased risk of malignancy (GI, pancreatic, breast, ovarian)

Answer 11

Peutz-Jeghers syndrome

Question 12

What lesion?

Diagnosed by family history and genetic testing

Answer 12

Peutz-Jeghers syndrome

Question 13

What lesion?

Oral/perioral biopsy is not supportive for diagnosis

Answer 13

Peutz-Jeghers syndrome

Question 14

What lesion?

Oral and perioral pigmentation persists throughout life and does not require tx

Answer 14

Peutz-Jeghers syndrome

Question 15

What lesion?

Tx = lifelong monitoring for development of neoplasia

Answer 15

Peutz-Jeghers syndrome

Question 16

What lesion?

Caused by amalgam becoming embedded in oral mucosa

Answer 16

Amalgam tattoo

Question 17

What lesion?

Pts w/ history of amalgam restorations

Answer 17

Amalgam tattoo

Question 18

What lesion?

Presents as black, blue, or gray macules

Answer 18

Amalgam tattoo

Question 19

What lesion?

Most common locations = gingiva, alveolar mucosa, and buccal mucosa

Answer 19

Amalgam tattoo

Question 20

What lesion?

May appear as a dense radiopacity on X-Ray

Answer 20

Amalgam tattoo

Question 21

What lesion?

Diagnosed by X-Ray and biopsy

Answer 21

Amalgam tattoo

Question 22

What lesion?

MUST be distinguished from melanocytic neoplasia

Answer 22

Amalgam tattoo

Question 23

When should you biopsy an amalgam tattoo?

Answer 23

When you take an X-Ray but don’t see a radiopacity

(if you see radiopacity then you know it’s amalgam, if not, you need to make sure it is not melanocytic neoplasia)

Question 24

What lesion?

Caused by protective response against noxious chemicals in tobacco smoke

Answer 24

Smoker’s melanosis

Question 25

What lesion? Females are affected at a higher frequency

Answer 25

Smoker's melanosis

Question 26

What lesion? Most common location = anterior facial mandibular gingiva

Answer 26

Smoker's melanosis

Question 27

What lesion? Looks like multiple brown macules

Answer 27

Smoker's melanosis

Question 28

What lesion? Correlate clinical presentation w/ smoking history and med history

Answer 28

Smoker's melanosis

Question 29

What lesion? If you have any doubt, biopsy to rule out neoplasia

Answer 29

Smoker's melanosis

Question 30

What lesion? Pigmentation can disappear after smoking cessation

Answer 30

Smoker's melanosis

Question 31

What lesion? Cause is different for different medications; some chelate w/ iron or melanin and deposit in lamina propria, some stimulate melanocytes to produce melanin

Answer 31

Drug-related pigmentation

Question 32

What lesion? Pt taking medication known to cause pigmentation

Answer 32

Drug-related pigmentation

Question 33

What 6 drugs are known to cause pigmentation?

Answer 33

Miocycline Antimalarials Tranquilizers Chemotherapeutic agents Estrogen AIDS meds

Question 34

What category are the following meds? Chloroquine Hydroxychloroquine Quinidine Quinacrine

Answer 34

Antimalarials

Question 35

What category is the following med? Chlorpromazine

Answer 35

Tranquilizers

Question 36

What category is the following med? Imatinib

Answer 36

Chemotherapeutic agents

Question 37

What category is the following med? Zidovudine/AZT

Answer 37

AIDS meds

Question 38

What lesion? Diffuse, painless, symmetric, bluish-gray macular pigmentation of hard palate

Answer 38

Drug-related pigmentation

Question 39

What lesion? Correlation btwn initiation of drug and onset of pigmentation

Answer 39

Drug-related pigmentation

Question 40

What lesion? Biopsy may be suggestive of drug-related pigmentation, or may require clinical correlation

Answer 40

Drug-related pigmentation

Question 41

What lesion? Increase in melanin and sometimes number of melanocytes

Answer 41

Melanotic macule

Question 42

What lesion? 2:1 female predilection

Answer 42

Melanotic macule

Question 43

What lesion? Average age is 42

Answer 43

Melanotic macule

Question 44

What lesion? Solitary, uniformly tan to dark-brown

Answer 44

Melanotic macule

Question 45

What lesion? Most common location = lower lip

Answer 45

Melanotic macule

Question 46

What lesion? Diagnosed by biopsy especially if recent onset, large size, irregular pigmentation, unknown duration, or recent enlargement

Answer 46

Melanotic macule

Question 47

What lesion? Caused by benign localized proliferation of nevus (melanocytic) cells derived from neural crest

Answer 47

Melanocytic nevus ("mole")

Question 48

What lesion? 10-40 cutaneous nevi per white adult (common)

Answer 48

Melanocytic nevus ("mole")

Question 49

What lesion? Uncommon intraorally, but can occur on any oral soft tissue site

Answer 49

Melanocytic nevus ("mole")

Question 50

What type of nevus? Brown/black macule

Answer 50

Junctional nevus

Question 51

What type of nevus? Brown/tan papule

Answer 51

Compound nevus

Question 52

What type of nevus? Brown/tan papule w/ papillomatous surface; hair may grow from center

Answer 52

Intradermal/intramucosal nevus

Question 53

What lesion? Clinical diagnosis can be made on skin, biopsy if there is any doubt

Answer 53

Melanocytic nevus ("mole")

Question 54

What lesion? Biopsy is necessary if it is intraoral

Answer 54

Melanocytic nevus ("mole")

Question 55

What lesion? Biopsy is necessary if > 6 mm

Answer 55

Melanocytic nevus ("mole")

Question 56

What lesion? Tx = monitor signs for change; small % develop into melanoma

Answer 56

Melanocytic nevus ("mole")

Question 57

What lesion? Caused by benign proliferation of dendritic melanocytes usually deep within CT

Answer 57

Blue nevus

Question 58

What lesion? Female predilection Usually in children + young adults

Answer 58

Blue nevus

Question 59

What lesion? Macular or dome-shaped, blue or blue-black

Answer 59

Blue nevus

Question 60

What lesion? Smaller than 1 cm

Answer 60

Blue nevus

Question 61

What lesion? Found on any cutaneous or mucosal site

Answer 61

Blue nevus

Question 62

What lesion? Most common oral location = palate

Answer 62

Blue nevus

Question 63

What lesion? Biopsy is a definitive diagnosis

Answer 63

Blue nevus

Question 64

What lesion? Tx = surgical excision

Answer 64

Blue nevus

Question 65

What lesion? Caused by malignancy of melanocytic cells

Answer 65

Melanoma

Question 66

What are the 4 risk factors for cutaneous melanoma?

Answer 66

Acute sun damage Fair complexion Multiple moles, freckling, dysplastic nevi Family hx

Question 67

What lesion? Male predilection Found in 5th-7th decade of life

Answer 67

Oral melanoma

Question 68

What % of melanomas are found in the following? Head and neck Extremities Intraoral

Answer 68

Head and neck: 25% Extremities: 40% Intraoral: < 1%

Question 69

What are the ABCDEs of melanoma?

Answer 69

Asymmetry Borders (irregular) Color variegation Diameter (> 6 mm) Evolving

Question 70

What lesion? Diagnosed by biopsy

Answer 70

Melanoma

Question 71

What lesion? Tx = wide surgical excision, radiation, immunotherapy

Answer 71

Melanoma

Question 72

What lesion? Depth of invasion is an important prognostic factor

Answer 72

Melanoma

Question 73

Which melanoma has a worse prognosis: oral melanoma or cutaneous melanoma?

Answer 73

Oral melanoma (< 20% 5-year survival)

Question 74

What lesion? Caused by decreased production of cortisol and mineralocorticoids; increased ACTH production by anterior pituitary

Answer 74

Addison disease

Question 75

What lesion? Caused by adrenocortical insufficiency secondary to autoimmune adrenalitis, TB, sarcoidosis, adrenal hemorrhage, and metastatic cancer

Answer 75

Addison disease

Question 76

What lesion? Effects broad range of people, dependent on cause

Answer 76

Addison disease

Question 77

What lesion? Generalized hyperpigmentation of the skin (bronzing)

Answer 77

Addison disease

Question 78

What lesion? Diffuse or patchy, brown, macular pigmentations of oral mucosa

Answer 78

Addison disease

Question 79

What lesion? Weakness, weight loss, irritability, depression, nausea, vomiting, hypotension

Answer 79

Addison disease

Question 80

What lesion? Diagnosed by decreased serum cortisol levels and increased plasma ACTH levels

Answer 80

Addison disease

Question 81

What lesion? Tx = steroid replacement therapy and tx of underlying condition

Answer 81

Addison disease

Question 82

T/F: You should always biopsy pigmented lesions

Answer 82

True

Question 83

What category of disease? Physiologic (racial) pigmentation

Answer 83

Developmental

Question 84

What category of disease? Peutz-Jeghers syndrome

Answer 84

Developmental

Question 85

What category of disease? Amalgam tattoo

Answer 85

Injury

Question 86

What category of disease? Smoker's melanosis

Answer 86

Injury

Question 87

What category of disease? Drug-related pigmentation

Answer 87

Injury

Question 88

What category of disease? Melanotic macule

Answer 88

Neoplastic

Question 89

What category of disease? Melanocytic nevus

Answer 89

Neoplastic

Question 90

What category of disease? Blue nevus

Answer 90

Neoplastic

Question 91

What category of disease? Melanoma

Answer 91

Neoplastic

Question 92

What category of disease? Addison disease

Answer 92

Metabolic