HIV oral melanosis

• On buccal mucosa, gingival, palate, tongue
• Brown macules
• Multifocal, diffuse, macular brown pigmentation

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Drug induced melanosis

• Hard palate
• Grey to blue black macules
• In patient taking drug therapies for 4+ months:
  • Quinolone
  • Hydroxyquinolone
  • Amodiaquine
  • Minocycline
  • Cyclophosphamide
  • Zidovudine

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Physiological pigmentation

• Gingiva
• Brown
• Symmetric and persistent pigmentation
• Normal gingival stippling
• Darker races

• Histology: Melanin in basal keratinocytes & connective tissue macrophages

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Oral melanotic macule

• Random
• Brown

• Types:
  • Idiopathic – intraoral freckles
  • Post inflammatory
  • Syndrome associated – Peutz-Jegher, Addison syndrome

• Histology: Excess melanin in basal keratinocytes & melanophagocytosis

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Melanoma

• Palate, gingiva
• Variable
• Neoplasm of epidermal melanocytes
• Elderly males
• Poor prognosis

• Clinical:

1. Early: Pigmented macule
2. Late:
   • A – Assymetry
   • B – Border’s irregular
   • C – Colour variable
   • D – Rapid increase in diameter
   • I – Induration
   • B – Bleeding
   • S – Satellite lesions (metastases)

• Subtypes:

1. In situ melanoma – prolonged proinvasive junction
2. Invasive melanoma – CT invasion

• Histology:
  • Dark staining intraepithelial melanocytes
  • Malignant round/spindle melanocytes with bizzare nuclei
  • Invading deep tissue

• Management:
  • Surgery
  • Chemotherapy

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Pituitary hyperfunction

• Adrenocorticotropic hormone (ACTH)
• Melanocyte-stimulating hormone (MSH)

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Other hormonal imbalance

• Pregnancy
• Contraceptive pills
• Female hormones

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Naevus

• Skin/mucosa
• Congenital tumor like malformations of skin/ mucosa – benign proliferation of melanocytes

• Subtypes:

1. Junctional: Melanocytes in – basal layer of epithelium
2. Intradermal: Melanocytes in – superficial layer of epithelium
3. Blue naevus: Melanocytes in – deep CT

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Smokers melanosis

• Anterior labial mucosa
• Abnormal melanin pigmentation:
  • Cigarette smoking
  • Females on birth control pills

• Histology: Melanin in basal keratinocytes and CT macrophages

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