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Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa

  • Special Issue: Colors and Textures, a Review of Oral Mucosal Entities
  • Published:
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Abstract

Black and brown pigmentation of the oral mucosa can occur due to a multitude of non-neoplastic causes. Endogenous or exogenous pigments may be responsible for oral discoloration which can range from innocuous to life-threatening in nature. Physiologic, reactive, and idiopathic melanin production seen in smoker’s melanosis, drug-related discolorations, melanotic macule, melanoacanthoma and systemic diseases are presented. Exogenous sources of pigmentation such as amalgam tattoo and black hairy tongue are also discussed. Determining the significance of mucosal pigmented lesions may represent a diagnostic challenge for clinicians. Biopsy is indicated whenever the source of pigmentation cannot be definitively identified based on the clinical presentation.

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References

  1. Meleti M, Vescovi P, Mooi WJ, van der Waal I. Pigmented lesions of the oral mucosa and perioral tissues: a flow-chart for the diagnosis and some recommendations for the management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(5):606–16.

    Article  PubMed  Google Scholar 

  2. Muller S. Melanin-associated pigmented lesions of the oral mucosa: presentation, differential diagnosis, and treatment. Dermatol Ther. 2010;23(3):220–9.

    Article  PubMed  Google Scholar 

  3. Amir E, Gorsky M, Buchner A, Sarnat H, Gat H. Physiologic pigmentation of the oral mucosa in Israeli children. Oral Surg Oral Med Oral Pathol. 1991;71(3):396–8.

    Article  PubMed  CAS  Google Scholar 

  4. Gorsky M, Buchner A, Moskona D, Aviv I. Physiologic pigmentation of the oral mucosa in Israeli Jews of different ethnic origin. Community Dent Oral Epidemiol. 1984;12(3):188–90.

    Article  PubMed  CAS  Google Scholar 

  5. Eisen D. Disorders of pigmentation in the oral cavity. Clin Dermatol. 2000;18(5):579–87.

    Article  PubMed  CAS  Google Scholar 

  6. Mallikarjuna K, Gupta S, Shukla S, Chaurasia S. Unusual extensive physiologic melanin pigmentation of the oral cavity: a clinical presentation. J Indian Soc Pedod Prev Dent. 2013;31(2):121–5.

    Article  PubMed  CAS  Google Scholar 

  7. Alawi F. Pigmented lesions of the oral cavity: an update. Dent Clin N Am. 2013;57(4):699–710.

    Article  PubMed  Google Scholar 

  8. Sreeja C, Ramakrishnan K, Vijayalakshmi D, Devi M, Aesha I, Vijayabanu B. Oral pigmentation: a review. J Pharm Bioallied Sci. 2015;7(Suppl 2):403–8.

    Article  Google Scholar 

  9. Gaeta GM, Satriano RA, Baroni A. Oral pigmented lesions. Clin Dermatol. 2002;20(3):286–8.

    Article  PubMed  Google Scholar 

  10. Mignogna MD, Lo Muzio L, Ruoppo E, Errico M, Amato M, Satriano RA. Oral manifestations of idiopathic lenticular mucocutaneous pigmentation (Laugier–Hunziker syndrome): a clinical, histopathological and ultrastructural review of 12 cases. Oral Dis. 1999;5(1):80–6.

    Article  PubMed  CAS  Google Scholar 

  11. Mozaffari HR, Rezaei F, Sharifi R, Mirbahari SG. Seven-year follow-up of Peutz–Jeghers syndrome. Case Rep Dent. 2016;2016:6052181.

    PubMed  PubMed Central  Google Scholar 

  12. Nieman LK, Chanco Turner ML. Addison’s disease. Clin Dermatol. 2006;24(4):276–80.

    Article  PubMed  Google Scholar 

  13. Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S. Addison’s disease. Contemp Clin Dent. 2012;3(4):484–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Neville B, Damm D, Allen C, Chi A. Oral and maxillofacial pathology. 4th ed. St. Louis: Elsevier; 2016.

    Google Scholar 

  15. Zhang Y, Ke Y, Zheng X, Liu Q, Duan X. Correlation between genotype and phenotype in three families with Peutz–Jeghers syndrome. Exp Ther Med. 2017;13(2):507–14.

    Article  PubMed  CAS  Google Scholar 

  16. Nikitakis NG, Koumaki D. Laugier–Hunziker syndrome: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(1):e52–8.

    Article  PubMed  Google Scholar 

  17. Rangwala S, Doherty CB, Katta R. Laugier–Hunziker syndrome: a case report and review of the literature. Dermatol Online J. 2010;16(12):9.

  18. Wang WM, Wang X, Duan N, Jiang HL, Huang XF. Laugier–Hunziker syndrome: a report of three cases and literature review. Int J Oral Sci. 2012;4(4):226–30.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Abduljabbar T, Vohra F, Akram Z, Ghani SMA, Al-Hamoudi N, Javed F. Efficacy of surgical laser therapy in the management of oral pigmented lesions: a systematic review. J Photochem Photobiol B. 2017;173:353–9.

    Article  PubMed  CAS  Google Scholar 

  20. Tosios KI, Kalogirou EM, Sklavounou A. Drug-associated hyperpigmentation of the oral mucosa: report of four cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125(3):e54–66.

    Article  PubMed  Google Scholar 

  21. Yuan A, Woo SB. Adverse drug events in the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(1):35–47.

    Article  PubMed  Google Scholar 

  22. Eisen D, Hakim MD. Minocycline-induced pigmentation. Incidence, prevention and management. Drug Saf. 1998;18(6):431–40.

    Article  PubMed  CAS  Google Scholar 

  23. Lerman MA, Karimbux N, Guze KA, Woo SB. Pigmentation of the hard palate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(1):8–12.

    Article  PubMed  Google Scholar 

  24. Treister NS, Magalnick D, Woo SB. Oral mucosal pigmentation secondary to minocycline therapy: report of two cases and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97(6):718–25.

    Article  PubMed  Google Scholar 

  25. Kaugars GE, Heise AP, Riley WT, Abbey LM, Svirsky JA. Oral melanotic macules. A review of 353 cases. Oral Surg Oral Med Oral Pathol. 1993;76(1):59–61.

    Article  PubMed  CAS  Google Scholar 

  26. Buchner A, Hansen LS. Melanotic macule of the oral mucosa. A clinicopathologic study of 105 cases. Oral Surg Oral Med Oral Pathol. 1979;48(3):244–9.

    Article  PubMed  CAS  Google Scholar 

  27. Buchner A, Merrell PW, Carpenter WM. Relative frequency of solitary melanocytic lesions of the oral mucosa. J Oral Pathol Med. 2004;33(9):550–7.

    Article  PubMed  CAS  Google Scholar 

  28. Shen ZY, Liu W, Bao ZX, Zhou ZT, Wang LZ. Oral melanotic macule and primary oral malignant melanoma: epidemiology, location involved, and clinical implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(1):e21–5.

    Article  PubMed  Google Scholar 

  29. Gupta G, Williams RE, Mackie RM. The labial melanotic macule: a review of 79 cases. Br J Dermatol. 1997;136(5):772–5.

    Article  PubMed  CAS  Google Scholar 

  30. Tavares TS, Meirelles DP, de Aguiar MCF, Caldeira PC. Pigmented lesions of the oral mucosa: a cross-sectional study of 458 histopathological specimens. Oral Dis. 2018. https://doi.org/10.1111/odi.12924.

    Article  PubMed  Google Scholar 

  31. Ho KK, Dervan P, O’Loughlin S, Powell FC. Labial melanotic macule: a clinical, histopathologic, and ultrastructural study. J Am Acad Dermatol. 1993;28(1):33–9.

    Article  PubMed  CAS  Google Scholar 

  32. Weathers DR, Corio RL, Crawford BE, Giansanti JS, Page LR. The labial melanotic macule. Oral Surg Oral Med Oral Pathol. 1976;42(2):196–205.

    Article  PubMed  CAS  Google Scholar 

  33. Page LR, Corio RL, Crawford BE, Giansanti JS, Weathers DR. The oral melanotic macule. Oral Surg Oral Med Oral Pathol. 1977;44(2):219–26.

    Article  PubMed  CAS  Google Scholar 

  34. Sexton FM, Maize JC. Melanotic macules and melanoacanthomas of the lip. A comparative study with census of the basal melanocyte population. Am J Dermatopathol. 1987;9(5):438–44.

    Article  PubMed  CAS  Google Scholar 

  35. Kauzman A, Pavone M, Blanas N, Bradley G. Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations. J Can Dent Assoc. 2004;70(10):682–3.

    PubMed  Google Scholar 

  36. Lambertini M, Patrizi A, Ravaioli GM, Dika E. Oral pigmentation in physiologic conditions, post inflammatory affections and systemic diseases. G Ital Dermatol Venereol. 2017. https://doi.org/10.23736/S0392-0488.17.05619-X

    Article  PubMed  Google Scholar 

  37. Uribe P, Collgros H, Scolyer RA, Menzies SW, Guitera P. In vivo reflectance confocal microscopy for the diagnosis of melanoma and melanotic macules of the lip. JAMA Dermatol. 2017;153(9):882–91.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hatch CL. Pigmented lesions of the oral cavity. Dent Clin N Am. 2005;49(1):185–201, ix–x.

  39. Tarakji B, Umair A, Prasad D, Alsakran Altamimi M. Diagnosis of oral pigmentations and malignant transformations. Singap Dent J. 2014;35C:39–46.

    Article  Google Scholar 

  40. Gondak RO, da Silva-Jorge R, Jorge J, Lopes MA, Vargas PA. Oral pigmented lesions: clinicopathologic features and review of the literature. Med Oral Patol Oral Cir Bucal. 2012;17(6):e919–24.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Rohilla K, Ramesh V, Balamurali P, Singh N. Oral melanoacanthoma of a rare intraoral site: case report and review of literature. Int J Clin Pediatr Dent. 2013;6(1):40–3.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Peters SM, Mandel L, Perrino MA. Oral melanoacanthoma of the palate: an unusual presentation of an uncommon entity. JAAD Case Rep. 2018;4(2):138–9.

  43. Cantudo-Sanagustin E, Gutierrez-Corrales A, Vigo-Martinez M, Serrera-Figallo MA, Torres-Lagares D, Gutierrez-Perez JL. Pathogenesis and clinicohistopathological characteristics of melanoacanthoma: a systematic review. J Clin Exp Dent. 2016;8(3):e327–36.

    PubMed  PubMed Central  Google Scholar 

  44. Hassona Y, Sawair F, Al-Karadsheh O, Scully C. Prevalence and clinical features of pigmented oral lesions. Int J Dermatol. 2016;55(9):1005–13.

    Article  PubMed  Google Scholar 

  45. Mirbod SM, Ahing SI. Tobacco-associated lesions of the oral cavity: Part I. Nonmalignant lesions. J Can Dent Assoc. 2000;66(5):252–6.

    PubMed  CAS  Google Scholar 

  46. Monteiro LS, Costa JA, da Camara MI, Albuquerque R, Martins M, Pacheco JJ, Salazar F, Figueira F. Aesthetic depigmentation of gingival smoker’s melanosis using carbon dioxide lasers. Case Rep Dent. 2015;2015:510589.

    PubMed  PubMed Central  Google Scholar 

  47. Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in U.S. adults: data from the Third National Health and Nutrition Examination Survey, 1988–1994. J Am Dent Assoc. 2004;135(9):1279–86.

    Article  PubMed  Google Scholar 

  48. Buchner A, Hansen LS. Amalgam pigmentation (amalgam tattoo) of the oral mucosa. A clinicopathologic study of 268 cases. Oral Surg Oral Med Oral Pathol. 1980;49(2):139–47.

    Article  PubMed  CAS  Google Scholar 

  49. Owens BM, Schuman NJ, Johnson WW. Oral amalgam tattoos: a diagnostic study. Compendium 1993;14(2):210, 212, 214 passim.

  50. Thumbigere-Math V, Johnson DK. Treatment of amalgam tattoo with a subepithelial connective tissue graft and acellular dermal matrix. J Int Acad Periodontol. 2014;16(2):50–4.

    PubMed  Google Scholar 

  51. Avcu N, Kanli A. The prevalence of tongue lesions in 5150 Turkish dental outpatients. Oral Dis. 2003;9(4):188–95.

    Article  PubMed  CAS  Google Scholar 

  52. Kullaa-Mikkonen A, Mikkonen M, Kotilainen R. Prevalence of different morphologic forms of the human tongue in young Finns. Oral Surg Oral Med Oral Pathol. 1982;53(2):152–6.

    Article  PubMed  CAS  Google Scholar 

  53. Motallebnejad M, Babaee N, Sakhdari S, Tavasoli M. An epidemiologic study of tongue lesions in 1901 Iranian dental outpatients. J Contemp Dent Pract. 2008;9(7):73–80.

    Article  PubMed  CAS  Google Scholar 

  54. Redman RS. Prevalence of geographic tongue, fissured tongue, median rhomboid glossitis, and hairy tongue among 3,611 Minnesota schoolchildren. Oral Surg Oral Med Oral Pathol. 1970;30(3):390–5.

    Article  PubMed  CAS  Google Scholar 

  55. Gurvits GE, Tan A. Black hairy tongue syndrome. World J Gastroenterol. 2014;20(31):10845–50.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Mangold AR, Torgerson RR, Rogers III RS. Diseases of the tongue. Clin Dermatol. 2016;34(4):458–69.

    Article  PubMed  Google Scholar 

  57. Schlager E, St Claire C, Ashack K, Khachemoune A. Black hairy tongue: predisposing factors, diagnosis, and treatment. Am J Clin Dermatol. 2017;18(4):563–9.

    Article  PubMed  Google Scholar 

  58. Manabe M, Lim HW, Winzer M, Loomis CA. Architectural organization of filiform papillae in normal and black hairy tongue epithelium: dissection of differentiation pathways in a complex human epithelium according to their patterns of keratin expression. Arch Dermatol. 1999;135(2):177–81.

    Article  PubMed  CAS  Google Scholar 

  59. Akcaboy M, Sahin S, Zorlu P, Senel S. Ranitidine-induced black tongue: a case report. Pediatr Dermatol. 2017;34(6):e334–6.

    Article  PubMed  Google Scholar 

  60. Farinha H, Martins V. Lingua villosa nigra associated with the use of electronic cigarette. Acta Med Port. 2015; 28(3):393.

    Article  PubMed  Google Scholar 

  61. Lawoyin D, Brown RS. Drug-induced black hairy tongue: diagnosis and management challenges. Dent Today 2008;27(1):60, 62, 3; quiz 93, 58.

  62. Nisa L, Giger R. Black hairy tongue. Am J Med. 2011;124(9):816–7.

    Article  PubMed  Google Scholar 

  63. Winzer M, Gilliar U, Ackerman AB. Hairy lesions of the oral cavity. Clinical and histopathologic differentiation of hairy leukoplakia from hairy tongue. Am J Dermatopathol. 1988;10(2):155–9.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Louisiana State University, 1100 Florida Avenue, New Orleans, LA, 70119, USA

    Molly S. Rosebush & Kitrina G. Cordell

  2. Central Ohio Skin & Cancer, Inc., Westerville, OH, USA

    Ashleigh N. Briody

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  1. Molly S. Rosebush
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  2. Ashleigh N. Briody
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Correspondence to Molly S. Rosebush.

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Rosebush, M.S., Briody, A.N. & Cordell, K.G. Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa. Head and Neck Pathol 13, 47–55 (2019). https://doi.org/10.1007/s12105-018-0980-9

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