Amalgam Tattoo ' macular pigmented lesion

   Amalgam Tattoo

Macular Pigmented lesion

INTRODUCTION

An amalgam tattoo oral mucosal lesion is a relatively common finding. The diagnosis is often relatively simple. However, the differential diagnosis is extensive, and failure to elucidate the correct diagnosis can be a serious issue. The differential diagnosis of macular pigmented oral mucosal lesions includes the following: amalgam tattoos, hemangioma, oral melanotic macules, melanocytic nevi, melanoacanthoma, smokers’ melanosis, racial/physiologic pigmentations, post-inflammatory pigmentations, medication-induced pigmentations, varices, heavy metal deposits, systemic disease/condition-related pigmentations (Peutz-Jeghers syndrome [PJS], Addison’s disease), and malignant melanoma

The diagnosis of an amalgam tattoo is based upon several factors, which include a history of prior dental restorative and surgical therapies, the length of time the lesion has been present, the clinical appearance of the lesion, the determinative differential diagnosis of other oral pigmented lesions, and radiographic and histopathologic findings.

DIFFERENTIAL DIAGNOSES OF ORAL MUCOSAL MACULAR PIGMENTATION MELANOACANTHOMA

Melanoacanthoma is an uncommon, benign, hyper-pigmented lesion. The clinical presentation is well-circumscribed, typically macular, dark-brown-to-black lesions. It preferentially occurs in young African American females and is relatively uncommon in white subjects. There is an association with continuing trauma. Approximately 20% of patients with melanoacanthoma present with multiple lesions. The histopathologic appearance is noted for the proliferation of dendritic melanocytes scattered through an acanthotic and hyperkeratotic epithelium. A biopsy is necessary for a definitive diagnosis.

Melanotic Macule

A melanotic macule is a benign macular oral pigmented lesion and a relatively commonly occurring oral lesion. The condition is due to increased melanin production, and melanotic macule lesions can occur singly or in multiples, although most often singly. This lesion typically presents as a solitary macular with a well-defined, smooth border and homogeneously pigmented lesions and varying in size from 1 to 2 cm (although they can be smaller than 1 cm) and varying in color from tan to dark brown. The condition is more common in females than males, and the age range is from 1 to 98 years old. The lesions of such systemic conditions as PJS are multiple melanotic macules. The most common oral locations are the gingiva, palate, lower lip, and buccal mucosa. The histopathologic appearance demonstrates increased melanin pigmentation within the melanocytes and keratinocytes within the basal layer of the stratified squamous epithelium and sometimes within the upper portion of the lamina propria. A biopsy should be considered to rule out a diagnosis of melanoma, especially with regard to palatal lesions

Pigmented Oral Nevi

Oral pigmented nevi are rare macular benign lesions. Melanocytic nevi are a variable group of benign melanocytic neoplasms. They are characteristically brown or blue. Pigmented nevi are separated into several histologic categories: junctional, intradermal/intramucosal, and compound nevi. Congenital nevi present at birth, and banal nevi, also known as acquired melanocytic nevi, present in childhood and may continue to enlarge in adults over time. The most common lesion site is the hard palate, and these lesions are typically round to ovoid and sometimes macular. As the palate is known as a site of oral malignant melanoma lesions, it is necessary to biopsy pigmented lesions of the hard palate. The most common site for the intramucosal nevus is the buccal mucosa. Histologically, nevi are formed by an accumulation of nevus cells in the basal epithelium, lamina propria, or both. The transformation of oral pigmented nevi to melanoma is questionable.

Post-Inflammatory Pigmentation

Chronic oral inflammatory mucosal disorders such as oral lichen planus can cause mucosal pigmentation. The condition is associated with darker complexions. The condition may present with multiple brown-to-black pigmented lesions of oral mucosal areas. The histopathologic picture notes increased melanin production by melanocytes and melanin-incorporated macrophages in the superficial lamina propria.

Systemic Disease/Condition and Physiologic-Related Oral Mucosal Hyperpigmentation

The main characteristic of this group of conditions is bilateralism.

Physiologic (Racial) Oral Mucosal Pigmentation

Physiological pigmentation is associated with dark-skinned populations. The most common oral mucosal location is the attached gingiva. The condition is usually bilateral, with irregular, poorly defined borders.

Smokers’ Melanosis

The condition of smoker’s melanosis presents as a black-brown oral mucosal pigmentation of the labial gingiva that is found in heavy smokers. The condition is more common in women compared to men.

Medication-Induced Mucocutaneous Pigmentation

Drug-induced mucocutaneous pigmentation is associated with the long-term utilization of a number of systemic medications, including tetracyclines, antimalarials, antifungals, anti-mycobacterial drugs, anti-retroviral drugs, chemotherapeutics, psychotropic drugs, and oral contraceptives .