Pigmented lesions

Classification

•1-melanotic:•a-localized

•b-diffuse

•2-Non melanotic:•A-endogenous:

•Lipopigments•Due to RBCs

•Vascular lesions

•B-exogenous•Black hairy tongue

•Tattoo•Metallic intoxification

1-Localized melanotic lesions

Ectodermal alteration

e.g.Acanthosis Nigericans

Unusual Dermatosis characterized by:

A-hyperkeratosis

B-melanin pigmentation

C-white oral lesions

Types:

Benign: associated with insulin resistant diabetes.

Malignant :internal malignancy release certain peptides ,stimulate melanin production.

Increased melanin production

1-Café au lait spots:

A-Multiple neurofibromatosis(Von Recklinhausen disease)

B-Polyostotic fibrous dysplasia.

A-multiple neurofibromatosis

It is an inherited autosomal dominant neuroectodermal abnormality ,characterized by proliferation of fibrous element of the nerve

Clinical features

1-Multiple nodules: sessile or pedunculated mostly affects the trunk

-Tongue involvement,appears as multiple nodules,due to lingual nerve involvement,scrotal tongue and enlarged fungiform papillae.

2 -Neurological manifestation: a-centrally located lesions (deafness ,pain ,epilepsy )

b-mandibular nerve involvement appears as R.L area associated with lip numbness

3 -Café au lait pigmentation:

More than 5mm prepubertal(

More than 15 mm in diameter: post pubertal

B-Polyostotic fibrous dysplasia

1-Jaffe type:

-unilateral bone involvement

-most bone are intact

Skin café au lait spots-

-no endocrinal involvement

2 -Albright syndrome

As Jaffe but have endocrinal disturbances:

-parathyroid

Thyroid

Pituitary

Gonads (precocious puberty)

2 -smoker melanosis

Diffuse brown flat macules ,mainly on anterior labial gingiva,in cigarette smokers

On the palate in pipe smokers

Pigmented lichen planus

This increase in melanogenesis may be stimulated by the infilterate of T-Lynphocytes,through the cytokines they produce

)Rare in erosive or papular form(

Melanocyte proliferation

1-nevocellular nevi

2-Melanoma

3 -Peutz-jegher syndrome

Oral melanotic naevi

Benign proliferation of melanocytes which form localized brown to black patches(5-6mm)

1 -junctional nevi :(flat, brown round or oval)

2-Compound nevi: proliferate down to C.T

)Dome shaped ,brown lesions(

3-Intradermal/intramucosal: localized in C.T

)elevated brown nodules(

4-Blue nevi: nevus reside deeply inside C.T

Junctional

intradermal Blue nevus

Compound

Melanoma/Malignant melanoma

Raised ,painless ,sessile or pedunculated.

Most commonly found on the palate and anterior labial gingiva.

Malignant transformation:-Increased pigmentation

Bleeding or ulceration --

Peutz- jegher syndrome

Clinical picture:

A-brown pigmentation: multiple melanotic macules (perioral-perinasal-perioccular)

Hands and feet also affected

Facial pigmentation may disappear but intra oral remain.

B-Intestinal polyposis

Physiologic pigmentation

Heamochromatosis

Primary :disorder of newborn ,due to increased intestinal iron absorption

Secoundry: due to increased iron intake, or increased RBCs destruction

Porphyria Hereditary disease caused by abnormalities in heme biosynthesis, results in increased porphyrinsTypes:

1-cutaneous hepatic porphyria:erythema ,then vesicles ,then form bullae,that heal by scar with skin hyperpigmentation

2-congenital erythropoeitic porphyria:

a-Excessive porphyrin in in bone marrow,causes photosensitivity ,then vesicular eruption.

-b- vesicles contain serous fluid with red fluorescenceC-red urine D-lavender teeth(both decidious and permanent teeth)

Pellagra

It is Niacin (nicotinic acid deficiency):1-Dermatitis with melanin pigmentation of skin

2-Dementia3-Diarrhea

4-Death

Oral manifestation:Stomatitis,glossitis,ANUG,Angular Cheilosis,Herpes labialis,deminution of taste sensation

Endocrinopathic pigmentation

Bronzing of skin and patchy melanosis of oral mucous membrane due to Pituitary hyperfunction or Addisons disease(increase in ACTH) stimulate melanocytes

HIV Melanosis

Flat ,Brown Macules

Mainly on buccal and labial mucosa

2-Non melanotic

A-endogenous:

-lipopigments

-RBCs

-Vascular lesions

Lipopigments

A-Lipochrome(Carotene):yellow or red fat soluble pigments found in carrots,tomato ,sweet potato,green leafs and egg yolk .

Excessive intake of carotene results in carotenemia

Results in yellow color of skin and mucous membrane ,(no eye involvement)

B-sebaceous glands

RBCs pigments

Extravasation due to trauma ,bleeding tendency or blood vessels abnormality

First red then turn brown due to hemosidirin

Ecchymosis

petechiae

Petechiae

Jaundice

1 -Hemolytic

2-hepatocellular

3-Obstructive jaundice

Hemangioma

Vascular lesions presenting proliferation of vascular channels are tumor like hamartomas.

-Close to epithelium appear red ,deep appear blue

Hemangioma

Portewine stain

Kaposis sarcoma

Rare tumour of vascular origin,accompany HIV infection

Sites: head ,neck ,tip of nose ,intra-orally: palate

Hereditary Hemorrhagic Telangiectasia

A Genetically transmitted disease ,inherited as an autosomal dominant trait, about 100 purple papule on the vermilion and mucosal surfaces of the lips and tongue.

Also the facial skin and neck are also involved.

Differential diagnosis:

Petechial hemorrhages with platelet disorders.

Varix

Pathological dilatation of veins and venules

mostly common intra orally in the ventral surface of the tongue appear as tortuous blue ,red and purple elevation(

Degenerative change in adventitia of venous walls as result of aging.

Exogenous pigmentation

Black hairy tongue

Tattoo: amalgam ,graphite

Metallic intoxification

Black Hairy tongue

Amalgam Tattoo

Metallic intoxification