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Oral Pathology
Pigmented Lesions
95
Pathology
01/31/2010

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Cards

Term
What is endogenous pigmentation?
Definition
Pigment produced from within the body
Term
What is exogenous pigmentation?
Definition
Pigment originating outside the body
Term
What are examples of endogenous pigmentation?
Definition
  • Physiologic (racial) pigmentation
  • Ephelis and oral melanotic macule
  • Pigmented cellular nevus
  • Malignant melanoma
  • Addison's disease
  • Peutz jeghers syndrome
Term
What are examples of exogenous pigmentation?
Definition
  • Smoker's melanosis
  • Foreign bodies
  • Amalgam tattoo
  • Plumbism (lead)
  • Bismuth
  • Graphite
Term
What is another name for physiologic pigmentation?
Definition
Racial pigmentation
Term
What causes racial pigmentation?
Definition
Normal amounts of melanin
Term
Racial pigmentation is most often found where?
Definition
Attached gingiva
Term
What causes smoker's melanosis?
Definition
A component in tobacco stimulates melanocytes
Term
Smoker's melanosis may disappear how long after smoking cessation?
Definition
3 years
Term
Smoker's melanosis is found in what percentage of smokers?
Definition
20 to 30 percent
Term
Which sex is predisposed to smoker's melanosis?
Definition
Females on birth control
Term
What are visual cues of smoker's melanosis?
Definition
  • Anterior gingiva of mandible for cigarette smokers
  • Buccal mucosa
  • Palate for pipe smoking
Term
What are other clinical features of smoker's melanosis?
Definition
  • Covered with intact mucosa
  • Diffuse irregular brown patches
Term
What is ephelis and melanotic macule?
Definition
Pigment synthesis by basal layer melanocytes
Term
What is another name for ephelis and melanotic macule?
Definition
  • Ephelis (freckle)
  • Oral melanotic macule
  • Labial melanotic macule
Term
Ephelis is located where?
Definition
  • Sun exposed areas
  • Lower lip
  • Can occur on the vermillion border
Term
Ephelis occurs at what age?
Definition
At any age
Term
Oral melanotic macule is found where?
Definition
  • Gingiva
  • Palate
  • Buccal mucosa
Term
What are other clinical features of oral melanotic macule?
Definition
  • Female predilection
  • Usually does not enlarge after diagnosis
  • Not dependent on sun exposure
Term
How do you treat ephelis and melanotic macule?
Definition
  • Excisional biopsy
  • Not predisposed to melanoma
Term
What is another name for pigmented cellular nevus?
Definition
  • Pigmented cellular mole
  • Melanocytic nevus
Term
What is the most common site in pigmented cellular nevus?
Definition
Palate
Term
What is the most common of all human "tumors"?
Definition
Pigmented cellular nevus
Term
What are other clinical features of pigmented cellular nevus?
Definition
  • History of long duration
  • Does not blanch
  • May regress
  • Uncommon in the oral cavity
Term
What are nevi derived from?
Definition
Neural crest cells
Term
What is junctional nevus?
Definition
Cells located at the junction of epithelium and connective tissue
Term
What is compound nevus?
Definition
Cells along the junctional area and within the underlying connective tissue
Term
What is intradermal nevus?
Definition
Cells only within the connective tissue
Term
What is another name for intradermal nevus in the oral cavity?
Definition
Intramucosal nevus
Term
What is the most common intraoral nevi?
Definition
Intradermal nevus
Term
What is blue nevus?
Definition
Spindle shaped cells deep within tissue
Term
What is the second most common intraoral nevi?
Definition
Blue nevus
Term
What are other clinical features of blue nevus?
Definition
  • Hard palate
  • Female predilection
Term
How do you treat pigmented cellular nevus?
Definition
  • Excisional biopsy
  • Some lesions lose color with age
  • May regress
Term
What is the third most common cancer of the skin?
Definition
Malignant melanoma
Term
What causes malignant melanoma?
Definition
Sunlight is strongly implicated
Term
What color is malignant melanoma?
Definition
  • Bluish black
  • Brown to non pigmented
Term
What clinical feature is common in malignant melanoma?
Definition
Ulceration
Term
What are other variations of nevi?
Definition
  • Halo nevus
  • Spitz nevus
  • Congenital melanotic nevus
Term
What is spitz nevus?
Definition
Benign juvenile melanoma
Term
What are the risk factors of malignant melanoma?
Definition
  • Fair complexion
  • Light hair
  • Tendency to sunburn
  • History of dysplastic or congenital nevus
  • Relative with malignant melanoma
Term
What is the prognosis for oral melanoma in 5 years?
Definition
45 percent
Term
What is the prognosis for oral melanoma in 10 years?
Definition
28 percent
Term
Malignant melanoma occurs in what two phases?
Definition
Radial and vertical growth phase
Term
What is radial growth phase of malignant melanoma?
Definition
  • Cells spread laterally
  • But stay confined to the surface epithelium
Term
What is vertical growth phase of malignant melanoma?
Definition
Cells invade and populate the connective tissue
Term
What are the common types of malignant melanoma?
Definition
  • Superficial spreading,
  • Nodular,
  • Lentigo malignant and
  • Acral lentiginous melanoma
Term
What is the most common form of malignant melanoma?
Definition
Superfical spreading melanoma
Term
What are the most common sites of superficial spreading melanoma?
Definition
Back of males and legs of females
Term
What causes nodular melanoma?
Definition
Vertical growth rapidly invades connective tissue creating nodular elevation
Term
Lentigo malignant melanoma develops from what precursor?
Definition
Lentigo maligna or hutchinson's freckle
Term
Lentigo malignant melanoma occurs almost exclusively where?
Definition
  • Sun exposed skin of fair complexioned elderly
  • In the mid face region
Term
Lentigo malignant melanoma represents what?
Definition
Melanoma in situ due to radial growth
Term
What is the most common form of malignant melanoma in blacks? 
Definition
Acral lentiginous melanoma
Term
What is the most common form of malignant melanoma in the oral cavity?
Definition
Acral lentiginous melanoma
Term
Oral malignant melanoma occurs at what age and sex?
Definition
40 to 70 year old males
Term
Oral malignant melanoma occurs where?
Definition
  • Maxillary ridge
  • Palate
Term
What are other clinical features of oral malignant melanoma?
Definition
  • Metastasize from skin
  • Often several months to years before malignancy appears
  • Poor prognosis
Term
What is the key to oral malignant melanoma?
Definition
Early diagnosis
Term
Classification systems to evaluate depth of invasion and prognosis?
Definition
Clark and breslow
Term
What is the clark system in the classification of melanoma?
Definition
  • Assigns level to lesion
  • Of the deepest region of tumor invasion
Term
What is the breslow system in the classification of melanoma?
Definition
  • Measures distance from granular cell layer to deepest region
  • Accurate correlation with prognosis
Term
What is the ABCD system of evaluation?
Definition
  • Asymmetry
  • Border irregularity
  • Color variation
  • Diameter greater than 6 mm
Term
What is addison's disease?
Definition
Destruction of adrenal cortex
Term
What causes destruction of the adrenal cortex in addison's disease?
Definition
  • Tuberculosis
  • Autoimmunity
  • Tumors
  • AIDS
Term
What results in addison's disease?
Definition
  • Lowers cortisol
  • Stimulates pituitary ACTH output
  • Increases levels of MSH
Term
What are other clinical features of addison's disease?
Definition
  • Generalized weakness and fatigue
  • Hypotension
  • Vomiting and diarrhea
Term
What is generalized abnormal pigmentation of addison's disease?
Definition
Bronzing
Term
Generalized abnormal pigmentation of addison's disease is located in what areas?
Definition
  • Skin folds
  • Joints
  • Areas of trauma
  • Mucous membranes
Term
Oral pigmentation in addison's disease occurs where?
Definition
  • Gingiva
  • Lateral tongue
  • Buccal mucosa
  • Lips
Term
How do you diagnose addison's disease?
Definition
ACTH stimulation test with plasma measurement of ACTH
Term
How do you treat addison's disease?
Definition
  • Corticosteroid replacement therapy
  • May need to be increased during stressful events
Term
What is the corticosteroid replacement therapy in addison's disease?
Definition
5 mg prednisone
Term
Peutz jeghers syndrome occurs at what age?
Definition
Early childhood
Term
What are other clinical features of peutz jeghers syndrome?
Definition
  • Rare
  • Hereditary in most cases
  • Intestinal polyps
  • Freckles do not change with sun exposure
Term
Intestinal polyps of peutz jeghers syndrome are especially located where?
Definition
Jejunum and ileum
Term
What do intestinal polyps of peutz jeghers syndrome cause?
Definition
Intestinal obstruction due to intussusception
Term
What percentage of intestinal polyps develop intestinal adenocarcinomas?
Definition
2 to 3 percent
Term
Oral pigmentation of peutz jeghers syndrome occurs where?
Definition
  • Buccal mucosa
  • Gingiva
  • Tongue
  • Palate
Term
Skin of the extremities are affected in what percentage of peutz jeghers syndrome?
Definition
50 percent
Term
Pigmentation of peutz jeghers syndrome primarily affects what areas?
Definition
  • Vermillion zone
  • Eyes
  • Nose
Term
What is key in diagnosing foreign bodies?
Definition
Good history
Term
Some foreign bodies elicit what?
Definition
Granulomatous reaction
Term
What is the most common intraoral soft tissue pigmentation?
Definition
Amalgam tattoo
Term
What are the most common areas of amalgam tattoo?
Definition
  • Gingiva
  • Buccal mucosa
  • Floor of mouth
Term
How do you diagnose amalgam tattoo?
Definition
Take radiographs
Term
What are the symptoms of lead (plumbism)?
Definition
  • GI disturbances
  • Peripheral neuritis
  • Encephalitis
  • Deposition of lead in growing bones
  • Hypochromic anemia with basophilic stippling of RBCs
Term
What are other clinical features of plumbism?
Definition
  • Excessive salivation
  • Metallic taste
  • Swollen salivary glands
  • May deposit in primary teeth
Term
What are the sources of metal in bismuth?
Definition
  • Previously used to treat syphilis
  • To treat some skin diseases
Term
Where is the "bismuth line" seen?
Definition
  • Gingiva
  • Buccal mucosa
  • Lips
  • Ventral tongue
Term
What causes the "bismuth line"?
Definition
  • Oral bacteria
  • Hydrogen sulfide causes precipitation of granules of bismuth sulfide
Term
How do you prevent bismuth?
Definition
Good oral hygiene
Term
What is the prognosis of bismuth?
Definition
  • Good
  • Disappears after discontinuance
Term
Any activity at the junction of junctional nevus can easily become what?
Definition
Malignant melanoma
Term
Lead sulfide in plumbism forms what?
Definition
A line in the gingiva