Topic #1: Pigmentations of Oral

and Peri-oral Tissues

Done by:
Abeer Khasawneh

Extrinsic stain or die

Melanocytes

Nevus cells

Freckles

Myxoma syndrome
(Carneys syndrome)

Lentigo

Melanotic macule

Melanotic macule

Melanotic macule

Increased melanin pigmentation

within the basal cell layer with
melanin incontinence.

Melanotic macule

Melanoacanthoma

Dendritic-shaped, pigmented melanocytes (arrows) are noted

throughout the full thickness of a spongiotic and acanthotic
epithelium.

Congenital Nevi (moles)

Classification

Intramucosal nevus

Intramucosal nevus

The nevus cells are located within

the submucosal tissue, with no
evidence of any junctional component.
The superficial melanocytes are heavily
pigmented. Melanin is less evident in
the remaining cells.

Intramucosal nevus

Compound nevus

Nevus cells are located at the

junction of the epithelium and
connective tissue and within the
submucosal tissue.
The cells are variably pigmented.

Compound nevus

Junctional nevus

Blue nevus

Skin Melanoma

Skin Melanoma

Malignant Oral Melanoma

Malignant Oral Melanoma

Macular but diffuse involvement of the maxillary gingiva.

Malignant Oral Melanoma

One portion of the tumor is

heavily pigmented (arrow),
whereas the opposite side is
relatively amelanotic.

Malignant Oral Melanoma

Melanoma of the upper lip

presenting as an ulcerated mass
with multifocal areas of
pigmentation.

Oral Melanoma

Nests of melanoma cells demonstrating nuclear

pleomorphism and hyperchromatism and deposits
of melanin pigment.

Oral Melanoma

Heavily pigmented melanoma

exhibiting primarily a radial
growth phase with pagetoid
spread of tumor cells
(hematoxylineosin stain).

Oral Melanoma

Neuroectodermal tumor of infancy

Physiologic pigmentation

Note the patchy distribution of the

pigment.

Physiologic pigmentation

Physiologic pigmentation

Melanin in a
macrophage

Smoking-associated melanosis

Post-inflammatory pigmentations

Lichen planusassociated
pigment. Classic-appearing
Wickhams striae and
surrounding pigmentation
(arrows) are seen in this
Caucasian patient with biopsyproven lichen planus.

Post-inflammatory pigmentations

Melasma

Pigmentation (arrows)
developed on the forehead
of this female during the second
trimester of pregnancy.

Melasma

Endocrinopathic pigmentations

Addisons disease

Addisons disease

Adrenocortical hyperfunction
Cushings disease (syndrome)

Peutz-Jeghers syndrome

Multiple small macules on the

fingertips (arrows).

Peutz-Jeghers syndrome

Skin pigmentations

Oral / perioral pigmentations

Intestinal polyps

Cutaneous menlanotic spots (Caf-au-Lait)

HIV-Associated melanosis

Laugier-Hunziker syndrome

Segmental vitiligo

Vitiligo

Ecchymosis-Haematoma

Diascopy

Haemochromatosis

Amalgam Tattoo

Amalgam Tattoo

Amalgam tattoo of the maxillary

alveolar mucosa. The pigment was
associated with a retrograde
amalgam restoration.

Amalgam Tattoo

Amalgam Tattoo

Amalgam particles are

dispersed throughout the
submucosal tissue.

Heavy metal pigmentations

Discoloration of the alveolar

mucosa associated with extensive
crown and bridge restoration.

Heavy metal pigmentations

Gingival staining due to poor quality

metals.

Heavy metal pigmentations

Generalized pigmentation due

to lead poisoning. The gingival
margin is pigmented.

Drug-induced pigmentations

Chlorpromazine

Quinidi
ne

Drug-induced pigmentations

Chlorquin
e

Hydroxyclorq
uine

Hairy tongue

THE END