1. Pigmented Lesions

2. Introduction
Pigmented lesions may be physiologic or pathologic. Some are considered to be benign and some are extremely malignant.

3. Variations of Normal Physiologic pigmentation: -racial/ hormonal
-on gingiva, tongue, lip
-do not blanch
(negative diascopy)
=>No Tx

4. Traumatic or Inflammatory Lesions
Amalgam tattoo
Titanium implants
Intentional Tattoos (ethnic, cosmetic)
Heavy metals

5. Amalgam tattoo
On gingiva =>adjacent to amalgam resto or extraction site
-Verified by radiograph
Differential diagnosis:
-Nevus
-Melanoma

6. Metal Pigmentations
Titanium Implants

7. Intentional Tattoo

8. Ethnic tattoos

9. Heavy Metal Pigmentation
Bismuth, lead, silver, copper, mercury:
Lead lines

10. Pigmentation Associated with Drugs: Minocycline (AB): black bone staining

11. Pigmentation Associated with Drugs: AZT :AIDS Meds

12. Pigmentation Associated with Drugs: Anticoagulant- induced lesions
.COMMON BRUSE >1CM

13. Smoker’s Melanosis Smoking increases oral cancer risk
Duty: patient education

14. Congenital or Genetic Disorders
Nevus
Oral melanotic macule (also inflamm)
Peutz- Jeghers disease
Addison’s disease

15. Nevus = “mole” Tx: biopsy gray, brown, and blue diascopy? DDX?
________________

16. Oral melanotic macule
On lip

17. Disease Associated Melanosis
Addison's disease
Peutz-Jeghers syndrome
Lung diseases
Kaposi's sarcoma

18. Addison’s disease:

19. Peutz-Jeghers syndrome:

20. Neoplasms
Oral melanoma
Cutaneous (Skin) melanoma

21. Neoplasms Oral melanoma
Very rare orally (compared to skin malenoma)
Risk factors:
-tobacco use
-chronic irritation
-familial history
Mostly on palate/ maxillary gingiva.
Can be pale colored= amelanotic melanoma
Very aggressive= metastasis
Tx: surgery, chemo, radiation
poor PX = low survival rate

22. ABCDEFG OF MELANOMA ASSYMETRY BORDER COLOUR DIAMETER ELEVATION
FAMILIAL PREDISPOSITION
GROWTH PATTERN

23. Raised Lesions with a Rough or Papillary Surface

24. Infections Specific etiological agent: Human Papillomavirus (HPV)
Clinical lesions:
-exophytic with cauliflower-like surface
DDX:
-Papilloma
-Verruca Vulgaris
-Condyloma acuminatum
-Focal epithelial hyperplasia

25. Oral squamous papilloma (oral wart)
Differential Diagnosis:
-Verruca vulgaris
-Condyloma acuminatum
-Verrucous carcinoma
TX: surgical removal

26. Verruca Vulgaris (common wart)

27. Condyloma acuminatum (genital or venereal warts)
Sexual contact
In children sex abuse of the child
Tx: surgery, high recurrence

28. Focal epithelial hyperplasia (Heck's disease)=>No Tx

29. Inflammatory or Reactive Lesions with a Papillary Configuration
Inflammatory papillary hyperplasia:
poor /loose fitting dentures TX: reline, new, remove at night assoc w candida

30. Neoplasms Associated with a Rough or Papillary Surface
Keratoacanthoma
Verrucous carcinoma

31. Keratoacanthoma
sebaceous glands -ON SUN EXPOSED LIP NOT ON ORAL MUCOSA common in whites
Note keratin center
associated with scc=>refer
Tx: surgery

32. Verrucous carcinoma spit tobacco (snuff or chewing tobacco) PLUS HPV
On: vestibular mucosa, alveolar ridge, and gingiva, buccal mucosa
Associated with snuff dipper
Consider: SCC
biopsy