OPATH pigmented lesions

• Melanocytes


  Melanin producing cells that have embryonic origin in the neural crest cells that have migrated to the epithelial surface where they reside among the basal epithelial cells
• Nevus Cell


  Relative type of melanocyte that is responsible for melanocytic nevi seen on the skin
• Melanocytic lesions


  • Can range from brown, black, and blue depending on the amount that they are produced from and depth of pigmented lesions relative to the surface (i.e., junctional, epithelial, basal)
• Physiologic (Ethnic) Pigmentation


  Symmetric and persistent, does not alter normal architecture (gingival stippling), any age, without gender predilection, may be found in any location, most commonly affected intraoral tissue: Gingiva, related to post inflammatory pigmentation, not due to increased number of melanocytes, but rather to increased melanin production, normal number of melanocytes, only increased in production
• Differential Diagnosis for Physiologic (Ethnic) Pigmentation

  • Smoking-Associated Melanosis
  • Peutz-Jeghers Syndrome
  • Addison's Disease
  • Melanoma
• Smoking-Related Melanosis


  Abnormal melanin pigmentation of oral mucosa by cigarette smoking, smoking up to 9 cigarettes per day has been sufficient to produce gingival melanin deposition, region most typically affected: Anterior labial gingiva, melanocytes show increased melanin production
• Oral Melanotic Macule


  Aka focal melanosis, predominantly on the vermilion of the lips and gingiva, resembles a mole inside the mouth, may represent an intraoral freckle, postinflammatory pigmentation, macules associated with Peutz-Jeghers Syndrome, Bandler Syndrome, Addison's Disease
• Oral Melanotic Macule has no malignant potential
• Histological Appearance of Oral Melanotic Macule

  • Characterized by melanin accumulation in basal keratinocytes and normal numbers of melanocytes, normal numbers of melanocytes but increased production of melanin, has no malignant transformation, no increase in number of cells, basal keratinocytes are intensely pigmented
• Differential Diagnosis for Oral Melanotic Macule

  • Blue nevi (palate)
  • Amalgam Tattoos
• Systemic Conditions Associated with Oral Melanotic Macules

  • Peutz-Jeghers Syndrome
  • Addison's Disease
  • Laugier-Hunziker Syndrome
  • Bandler Syndrome
• Café-au-Lait Macule


  Discrete melanin-pigmented patches of skin that have irregular margins and a uniform brown coloration, can be noted soon after birth, may be seen normally in children or a component of a syndrome, > 0.5 cm diameter = prepubertal, > 1.5 cm diameter = postpubertal, should be suspected of having neurofibromatosis
• Conditions Associated with Café-au-Lait Macules

  • McCune-Albright's Syndrome
  • Noonan Syndrome
  • Watson Syndrome
  • Bloom Syndrome
  • Ring Chromosome Syndrome
  • Neurofibromatosis
• Pigmented Neuroectodermal Tumor of Infancy

  A rare benign fast-growing neoplasm composed of primitive pigment-producing cells, biophysic tumor, composed of melanin-producing cells and fibroblastic cells, similar to melanocytes and mucous cells, origin: Neural Crest, infants usually younger than 6 months, more than 90% of cases occur in children younger than 1 year of age (newborn), common in maxilla
• Radiographic Appearance of Pigmented Neuroectodermal Tumor of Infancy

  • Presents as a non-ulcerated darkly pigmented mass, due to melanin production by the tumor cells, ill-defined radiolucency that may contain developing teeth
• Histological Appearance of Pigmented Neuroectodermal Tumor of Infancy

  • Exhibit alveolar pattern wherein the nest of tumor cells have small amount of intervening tissue, round to oval cells are found within a well-defined connective tissue margin, has variability in size, cells that are centrally located with neoplastic cells that are compact resembling neuroendocrine cells, peripheral cells are larger and often contain melanin
• Differential Diagnosis for Pigmented Neuroectodermal Tumor of Infancy

  • Neuroblastoma
  • Rhabdomyosarcoma
  • Histiocytic tumors
  • Odontogenic cystic tumors
• Melanocytic Nevus


  Refer to any congenital lesion of various cell types or tissue types, if there's no modifier, it's position generally is composed of nevus or melanocytic cells, sometimes it is called nevocellular nevus, pigmented
• Melanocytic nevi are also called moles
• Pigmented Neuroectoderal Tumor


  • Contains melanin
  • Differential diagnosis includes neuroblastoma, rhabdomyosarcoma, histiocytic tumors, odontogenic cystic tumors
  • Treatment is local surgical excision with good results
  • Local recurrence may occur in 10-20% of cases
  • Malignant transformation is rare
• Nevus (mole)


  Any congenital lesion of various cell types or tissue types
• Types of melanocytic nevus

  • Intramucosal nevus
  • Blue nevus
  • Compound nevus
  • Junctional nevus
• Melanocytic nevi are usually asymptomatic and benign, except for the junctional nevus which has malignant potential
• Junctional nevus


  Nevus cells located at the epithelium-connective tissue junction
• Intradermal nevus or intramucosal nevus


  Nevus cells located in the connective tissue
• Compound nevus


  Nevus cells located in both the epithelium and connective tissue
• Blue nevus


  Spindle-shaped nevus cells found deep in the connective tissue
• Melanoacanthoma


  • Uncommon benign pigmented lesion with proliferation of dendritic melanocytes within an acanthotic epithelium
  • Lesions are usually solitary but can be multifocal
  • Minimally elevated with a tendency for rapid growth, raising concern over malignancy
  • May disappear spontaneously or after biopsy
• Cutaneous melanoma


  • Now represents approximately 2% of all cancers
  • More common in locations closer to the equator with greater UV exposure
  • Predisposing factors include extensive sun exposure during childhood
  • More common in whites than blacks and Asians
• In situ melanoma


  Confined to the epithelium
• Invasive melanoma


  Spread to the connective tissue, can metastasize, crosses the junctional area
• Treatment and prognosis for melanoma

  • Surgery is the primary treatment, chemotherapy and radiotherapy may also be used
  • Prognosis depends on tumor invasion
• Amalgam tattoo (focal argyrosis)


  Iatrogenic lesion following traumatic soft tissue implantation of amalgam particles
• Amalgam tattoo is the most common pigmentation of oral mucous membranes
• Amalgam tattoo lesions are macular and gray, may be detected on soft tissue radiographs
• Histologically, silver in amalgam stains collagen and elastic fibers black or golden brown, with few inflammatory cells except when particles are large
• Drugs with oral pigment-producing potential

  • Amiodarone
  • Aminoquinolines
  • Clofazimine
  • Cyclophosphamide
  • Heavy metal-containing compounds
  • Quinacrine
  • Minocycline
  • Premarin
  • Zidovudine
  • Tetracycline
• Heavy metal pigmentations


  • May cause gray to black pigmentation, often in a linear distribution along the gingival margin
  • Occurs predominantly after occupational exposure to metal vapors
• Bismuth and lead staining of gingival tissues is known as a bismuth line and a lead line, respectively
• Compound nevus has junctional cells extending into the dermis but not forming nests.