PIGMENTED LESIONS

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PIGMENTED LESIONS:

PIGMENTED LESIONS DR. SHAFAQ SALIM

Acknowledgement:

Acknowledgement Dr. Batool Mohsin Khan

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Oral mucosa is deeply colored when compared to skin. Color reflects the clinical state of the mucosa; inflamed tissues are red, because of the increase in number and dilation of blood vessels, whereas normal healthy tissues are pale pink. The color of the oral mucosa is due to two main endogenous pigments namely- Melanin and hemoglobin. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

WHAT IS ORAL PIGMENTATION? :

WHAT IS ORAL PIGMENTATION? Oral pigmentation refers to discoloration of the inner lining of the mouth (oral mucosa) from its normally pink hue. It can be exogenous or endogenous in origin : 3/24/2014 Prepared by Dr. Batool Mohsin Khan

CLASSIFICATION OF PIGMENTED LESIONS:

CLASSIFICATION OF PIGMENTED LESIONS DEVELOPMENTAL DISORDERS: Peutz-Jeghers syndrome Forbes-Albright syndrome ENDOCRINOLOGICAL DISORDERS: Addison’s disease Cushing’s syndrome Hyperthyriodism DEFFICIENCY DISORDERS: Vitamin B12 deficiency DRUG INDUCED: Chlorhexidine Minocycline Quinine RACIAL 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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SPECIFIC AGENTS: Dental Amalgam (Amalgam tatto ) Chewing/Smoking of Tobacco Betel nut chewing Lead Silver NEOPLASTIC DISORDERS: Malignant Melanoma Kaposi sarcoma 3/24/2014 Prepared by Dr. Batool Mohsin Khan

DEVELOPMENTAL DISORDERS:

DEVELOPMENTAL DISORDERS PEUTZ – JEGHERS SYNDROME: Also known as ‘hereditary intestinal polyposis syndrome’ It is rare autosomal dominant genetic disorder, characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyper pigmented macules on the lips and oral mucosa. CLINICAL FEATURES: Rare, both male and female. Generalized intestinal polyposis and pigmented spots on face and oral cavity. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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Appear as small brown melanotic macules . Common on gingiva , tongue, buccal mucosa, hard palate and lips. MANAGEMENT: Facial pigmentation usually fades after puberty, however mucosal pigmentation persists. No treatment is required for oral lesions. The patient should be monitored for the development of internal malignancies. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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3/24/2014 Prepared by Dr. Batool Mohsin Khan

ENDOCRINOLOGICAL DISORDERS::

ENDOCRINOLOGICAL DISORDERS: ADDISON’S DISEASE: Addison’s disease, or primary hypoadrenalism , is due to progressive bilateral destruction of the adrenal cortex by autoimmune disease, infection or malignancy. The lack of adreno -cortical hormones in the blood stimulates hormone (ACTH) by the anterior pituitary gland. The increased production of ACTH induces melanocyte stimulating hormone, which results in diffuse pigmentation of the skin and oral mucosa. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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CLINICAL FEATURES: Diffuse brown patches on the gingiva , buccal mucosa, palate and tongue. Cushing’s syndrome, acromegaly and hyperthyroidism also show pigmentation similar to Addison’s disease. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

DRUG INDUCED::

DRUG INDUCED: MINOCYCLINE : Broad-spectrum tetracycline antibiotic. Causes grey to blackish discoloration of teeth, gingiva and alveolar bone. QUININE: Chloroquine and other quinine derivatives are used in the treatment of malaria, cardiac arrhythmia and a various immunologic diseases. Causes blue grey or blue black discoloration of mucosa. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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CHLORHEXIDINE: It is a chemical antiseptic. Mouth rinses containing chlorhexidine may also cause oral pigmentation. Causes brown staining of teeth. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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RACIAL/PHYSIOLOGIC PIGMENTATION: Physiologic pigmentation occurs due to an increased melanocytic activity rather than an increase in the number of melanocytes . Seen mainly in Blacks(Africans) and Asians. Some times in White those of Mediterranean descent. Color ranges from light to dark brown. Most obvious in anterior labial gingiva (attached gingiva ) where it appears as a bilateral, well-demarcated, ribbon-like, dark brown band, and palatal mucosa. The pigmentation is symmetrically distributed. Asymptomatic and require no treatment. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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3/24/2014 Prepared by Dr. Batool Mohsin Khan

SPECIFIC AGENTS::

SPECIFIC AGENTS: AMALGAM TATTO: Also known as focal argyrosis . An amalgam tattoo is an area of discoloration in the mouth caused by the migration of particles of  dental amalgam  which become embedded under the oral membranes, causing a patch of gray, black, or blue to appear. CLINICAL FEATURES: Most common cause of single patch of blue black pigmentation. Non elevated area beneath normal mucosa. Asymptomatic. Does not change in size and color. Radio opaque. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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Usually seen in mandibular gingiva or close to the teeth scar of an apicectomy where there has been retrograde root filling. MANAGEMENT: Lesions are of no clinical importance, but excisional biopsy is used to distinguish it from melanoma. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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3/24/2014 Prepared by Dr. Batool Mohsin Khan

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SMOKER’S MELANOSIS: Smoker’s melanosis is a phenomenon of increased melanin pigmentation seen in heavy smokers, most commonly cigarette smokers. This pigmentation is thought to be caused by increased melanin production in response to heat or exposure to tobacco smoke. The most common location of smoker’s melanosis is the labial gingiva (brown black pigmentation). Smoker’s melanosis seen in pipe smokers most often is noted on the buccal mucosa or the commissure of the lip along the vermilion border. Smoker’s melanosis usually disappears within 3 years of smoking cessation. Biopsy should be performed if there is surface elevation or increased pigment intensity. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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3/24/2014 Prepared by Dr. Batool Mohsin Khan

NEOPLASTIC DISORDERS::

NEOPLASTIC DISORDERS: MALIGNANT MELANOMA: Melanoma is a malignant neoplasm of the epidermal melanocytes , along the junction between the epithelial and connective tissues, as well as within the connective tissue. CLINICAL FEATURES: Slightly more common in men than women. 70 % of the cases involve the posterior maxillary alveolar ridges and hard palate. It appear as dark brown or bluish black slightly raised lesion with an uneven nodular or papillary surface. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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Occurence of satellite pigmented spots and regional lymph node enlargement. PROGNOSIS: Superficial melanoma have better prognosis than cutaneous lesions. TREATMENT: Radial surgical excision with clear margins. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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3/24/2014 Prepared by Dr. Batool Mohsin Khan

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KAPOSI SARCOME: Kaposi sarcoma is a tumor caused by Human herpesvirus 8 (HHV8) associated with HIV. CLINICAL FEATURES: More common in males than females. Involves skin and mucosal surface and presents first as reddish purple patches which then becomes nodular. In oral cavity seen commonly on hard palate, gingiva and tongue. TREATMENT: Antiviral therapy against the AIDS virus. Chemotherapy, cryotherapy and radiation therapy. 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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3/24/2014 Prepared by Dr. Batool Mohsin Khan

THANKYOU:

THANKYOU 3/24/2014 Prepared by Dr. Batool Mohsin Khan

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