Oral Medicine

Topic #1: Pigmentations of Oral and Peri-oral Tissues

Done by:Abeer KhasawnehExtrinsic stain or die

Melanocytes

Nevus cells

Freckles

Myxoma syndrome (Carneys syndrome)

Lentigo

Melanotic macule

Melanotic maculeMelanotic macule

Increased melanin pigmentation within the basal cell layer with melanin incontinence.

Melanotic maculeMelanoacanthoma

Dendritic-shaped, pigmented melanocytes (arrows) are noted throughout the full thickness of a spongiotic and acanthotic epithelium.Congenital Nevi (moles)

Classification

Intramucosal nevusIntramucosal nevus

The nevus cells are located withinthe submucosal tissue, with no evidence of any junctional component. The superficial melanocytes are heavily pigmented. Melanin is less evident in the remaining cells.Intramucosal nevus

Compound nevus

Nevus cells are located at the junction of the epithelium and connective tissue and within the submucosal tissue.The cells are variably pigmented.Compound nevus

Junctional nevus

Blue nevus

Skin Melanoma

Skin Melanoma

Malignant Oral Melanoma

Malignant Oral MelanomaMacular but diffuse involvement of the maxillary gingiva.

One portion of the tumor is heavily pigmented (arrow), whereas the opposite side is relatively amelanotic.Malignant Oral Melanoma

Melanoma of the upper lip presenting as an ulcerated mass with multifocal areas of pigmentation.Malignant Oral MelanomaOral Melanoma

Nests of melanoma cells demonstrating nuclear pleomorphism and hyperchromatism and deposits of melanin pigment.

Heavily pigmented melanoma exhibiting primarily a radial growth phase with pagetoid spread of tumor cells (hematoxylineosin stain).Oral MelanomaOral Melanoma

Neuroectodermal tumor of infancy

Note the patchy distribution of the pigment.Physiologic pigmentation

Physiologic pigmentation

Physiologic pigmentationMelanin in a macrophageSmoking-associated melanosis

Lichen planusassociated pigment. Classic-appearing Wickhams striae and surrounding pigmentation (arrows) are seen in this Caucasian patient with biopsy-proven lichen planus.Post-inflammatory pigmentationsPost-inflammatory pigmentations

Melasma

Pigmentation (arrows) developed on the foreheadof this female during the second trimester of pregnancy.

MelasmaEndocrinopathic pigmentations

Addisons disease

Addisons diseaseAdrenocortical hyperfunctionCushings disease (syndrome)

Peutz-Jeghers syndrome

Multiple small macules on the fingertips (arrows).Peutz-Jeghers syndromeSkin pigmentationsOral / perioral pigmentationsIntestinal polypsCutaneous menlanotic spots (Caf-au-Lait)

HIV-Associated melanosis

Laugier-Hunziker syndrome

Segmental vitiligo

Vitiligo

Ecchymosis-Haematoma

Diascopy

Haemochromatosis

Amalgam Tattoo

Amalgam tattoo of the maxillary alveolar mucosa. The pigment was associated with a retrograde amalgam restoration.Amalgam TattooAmalgam Tattoo

Amalgam particles are dispersed throughout the submucosal tissue.Amalgam TattooHeavy metal pigmentations

Discoloration of the alveolar mucosa associated with extensive crown and bridge restoration.Heavy metal pigmentations

Gingival staining due to poor quality metals.Heavy metal pigmentations

Generalized pigmentation due to lead poisoning. The gingival margin is pigmented.Drug-induced pigmentations

QuinidineChlorpromazine

Drug-induced pigmentations

Chlorquine

HydroxyclorquineHairy tongue

The end