Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review
Abstract
:Simple Summary
Abstract
1. Introduction
2. Melanin-Associated Pigmented Lesions
2.1. Ephelides (Freckles)
2.2. Oral/Labial Melanotic Macules
2.3. Racial Pigmentation
2.4. Oral Melanoma
2.5. Oral Tobacco Pigmentation/Smoker’s Melanosis
2.6. Melanoacanthoma
3. Non-Melanin Associated Pigmented Lesions
3.1. Endogenous Pigmentation
3.2. Exogenous Pigmentation and Amalgam Tattoos
4. Drug Induced Oral Melanosis
Drug-Induced Mucosal Pigmentation
5. Systemic Disorders
5.1. Peutz–Jeghers Syndrome
5.2. Addison’s Disease
6. Post-Inflammatory Pigmentations
Pigmented Oral Lichen Planus
7. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Disease | Clinical-Feature | Cause | Treatment | Differential Diagnosis |
---|---|---|---|---|
Ephelides/Freckles | Benign, hyperpigmented pigmentations; caused by an augmented melanin synthesis. | Sun-exposed dermal areas in individuals with lighter skin tones. | Vigilant monitoring for alterations in dimensions; no treatment needed. | MM; PJS. |
Oral/Labial Melanotic Macules | Brown-to-black small pigmentations, often a few millimeters. Caused by intrinsic and extrinsic factors. | Multifactorial genetic factors and extrinsic environmental influences. Typically, lower lip. | Surgical biopsy. | Ephelides/Freckles; PJS; OMM; |
Ethnic Pigmentation | Predominantly affects dark-skinned individuals; Manifests as dark brown to black; most affected site is the gingiva. | Increased quantity of melanin deposited on the epithelial basal layer. | No treatment needed. | PJS; Addison’s Disease; DIOM. |
Oral Melanoma | Brown to black hyperpigmentation of the oral mucosa, often with irregular borders. | Tobacco consumption; Genetical predisposition; Generally unknown. | Incisional/excisional biopsy for the diagnosis and then surgical approach + immunotherapy and radiotherapy. | MM; Melanoacanthoma; Exogenous Pigmentation. |
Oral Tobacco Pigmentations | Brown to brown-black hyperpigmentation of the oral mucosa. | Tobacco consumption; | Cessation of tobacco usage. | OMM; Melanoacanthoma. |
Melanoacanthoma | Solitary, well-circumscribed macules or plaques, brown to black pigmentation. | Unknown. | No treatment needed. | OMM. |
Endogenous Pigmentation | The lesions appear purple, red or brown in color. | Multifactorial; consequence of alterations or genetic disorders. | No treatment needed; Surgical biopsy for differential diagnosis. | OMM; MM; Melanoacanthoma. |
Exogenous Pigmentation | Foreign substances being introduced into the oral mucosa; typically gray, blue or black spots; Variable dimensions. | Performed dental works, Can be confirmed by radiograph. | No treatment needed; Surgical biopsy for differential diagnosis. | MM. |
Drug-Induced Oral Melanosis | Single or multiple sites (most affected hard palate, gingiva, and tongue); variable in dimensions. | Intake of certain drugs (such as chloroquine, quinacrine); | No oral treatment needed. | MM; Exogenous Pigmentation. |
Peutz–Jeghers Syndrome | Pigmented lesions on the lips and inside the mouth, often a few millimeters; Brown-to-black. | Direct consequence of the systemic disease, linked to mutations in the STK11 gene. | No oral treatment needed; Tests for intestinal polyposis can be useful. | Ephelides/Freckles; MM; Exogenous Pigmentation. |
Addison’s Disease | Brown hyperpigmentation of the oral mucosa. | Endocrinopathy. | Treat the sistemic condition; Endocrinological tests can be useful. | MM; PJS; Exogenous Pigmentation. |
Pigmented Oral Lichen Planus | Brown macules with white patches and stripes. | Post-inflammatory pigmentation on existing OLP. | Vigilant monitoring; no treatment needed. | Oral Tobacco Pigmentations; DIOM; MM. |
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Abati, S.; Sandri, G.F.; Finotello, L.; Polizzi, E. Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review. Cancers 2024, 16, 2487. https://doi.org/10.3390/cancers16132487
Abati S, Sandri GF, Finotello L, Polizzi E. Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review. Cancers. 2024; 16(13):2487. https://doi.org/10.3390/cancers16132487
Chicago/Turabian StyleAbati, Silvio, Giacomo Francesco Sandri, Leonardo Finotello, and Elisabetta Polizzi. 2024. "Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review" Cancers 16, no. 13: 2487. https://doi.org/10.3390/cancers16132487
APA StyleAbati, S., Sandri, G. F., Finotello, L., & Polizzi, E. (2024). Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review. Cancers, 16(13), 2487. https://doi.org/10.3390/cancers16132487