pigmented lesions
TRANSCRIPT
Pigmented lesions
Classification
•1-melanotic:•a-localized
•b-diffuse
•2-Non melanotic:•A-endogenous:
•Lipopigments•Due to RBCs
•Vascular lesions
•B-exogenous•Black hairy tongue
•Tattoo•Metallic intoxification
1-Localized melanotic lesions
Ectodermal alteration
e.g.Acanthosis Nigericans
Unusual Dermatosis characterized by:
A-hyperkeratosis
B-melanin pigmentation
C-white oral lesions
Types:
Benign: associated with insulin resistant diabetes.
Malignant :internal malignancy release certain peptides ,stimulate melanin production.
Increased melanin production
1-Café au lait spots:
A-Multiple neurofibromatosis(Von Recklinhausen disease)
B-Polyostotic fibrous dysplasia.
A-multiple neurofibromatosis
It is an inherited autosomal dominant neuroectodermal abnormality ,characterized by proliferation of fibrous element of the nerve
Clinical features
1-Multiple nodules: sessile or pedunculated mostly affects the trunk
-Tongue involvement,appears as multiple nodules,due to lingual nerve involvement,scrotal tongue and enlarged fungiform papillae.
2 -Neurological manifestation: a-centrally located lesions (deafness ,pain ,epilepsy )
b-mandibular nerve involvement appears as R.L area associated with lip numbness
3 -Café au lait pigmentation:
More than 5mm prepubertal(
More than 15 mm in diameter: post pubertal
B-Polyostotic fibrous dysplasia
1-Jaffe type:
-unilateral bone involvement
-most bone are intact
Skin café au lait spots-
-no endocrinal involvement
2 -Albright syndrome
As Jaffe but have endocrinal disturbances:
-parathyroid
Thyroid
Pituitary
Gonads (precocious puberty)
2 -smoker melanosis
Diffuse brown flat macules ,mainly on anterior labial gingiva,in cigarette smokers
On the palate in pipe smokers
Pigmented lichen planus
This increase in melanogenesis may be stimulated by the infilterate of T-Lynphocytes,through the cytokines they produce
)Rare in erosive or papular form(
Melanocyte proliferation
1-nevocellular nevi
2-Melanoma
3 -Peutz-jegher syndrome
Oral melanotic naevi
Benign proliferation of melanocytes which form localized brown to black patches(5-6mm)
1 -junctional nevi :(flat, brown round or oval)
2-Compound nevi: proliferate down to C.T
)Dome shaped ,brown lesions(
3-Intradermal/intramucosal: localized in C.T
)elevated brown nodules(
4-Blue nevi: nevus reside deeply inside C.T
Junctional
intradermal Blue nevus
Compound
Melanoma/Malignant melanoma
Raised ,painless ,sessile or pedunculated.
Most commonly found on the palate and anterior labial gingiva.
Malignant transformation:-Increased pigmentation
Bleeding or ulceration --
Peutz- jegher syndrome
Clinical picture:
A-brown pigmentation: multiple melanotic macules (perioral-perinasal-perioccular)
Hands and feet also affected
Facial pigmentation may disappear but intra oral remain.
B-Intestinal polyposis
Physiologic pigmentation
Heamochromatosis
Primary :disorder of newborn ,due to increased intestinal iron absorption
Secoundry: due to increased iron intake, or increased RBCs destruction
Porphyria Hereditary disease caused by abnormalities in heme biosynthesis, results in increased porphyrinsTypes:
1-cutaneous hepatic porphyria:erythema ,then vesicles ,then form bullae,that heal by scar with skin hyperpigmentation
2-congenital erythropoeitic porphyria:
a-Excessive porphyrin in in bone marrow,causes photosensitivity ,then vesicular eruption.
-b- vesicles contain serous fluid with red fluorescenceC-red urine D-lavender teeth(both decidious and permanent teeth)
Pellagra
It is Niacin (nicotinic acid deficiency):1-Dermatitis with melanin pigmentation of skin
2-Dementia3-Diarrhea
4-Death
Oral manifestation:Stomatitis,glossitis,ANUG,Angular Cheilosis,Herpes labialis,deminution of taste sensation
Endocrinopathic pigmentation
Bronzing of skin and patchy melanosis of oral mucous membrane due to Pituitary hyperfunction or Addisons disease(increase in ACTH) stimulate melanocytes
HIV Melanosis
Flat ,Brown Macules
Mainly on buccal and labial mucosa
2-Non melanotic
A-endogenous:
-lipopigments
-RBCs
-Vascular lesions
Lipopigments
A-Lipochrome(Carotene):yellow or red fat soluble pigments found in carrots,tomato ,sweet potato,green leafs and egg yolk .
Excessive intake of carotene results in carotenemia
Results in yellow color of skin and mucous membrane ,(no eye involvement)
B-sebaceous glands
RBCs pigments
Extravasation due to trauma ,bleeding tendency or blood vessels abnormality
First red then turn brown due to hemosidirin
Ecchymosis
petechiae
Petechiae
Jaundice
1 -Hemolytic
2-hepatocellular
3-Obstructive jaundice
Hemangioma
Vascular lesions presenting proliferation of vascular channels are tumor like hamartomas.
-Close to epithelium appear red ,deep appear blue
Hemangioma
Portewine stain
Kaposis sarcoma
Rare tumour of vascular origin,accompany HIV infection
Sites: head ,neck ,tip of nose ,intra-orally: palate
Hereditary Hemorrhagic Telangiectasia
A Genetically transmitted disease ,inherited as an autosomal dominant trait, about 100 purple papule on the vermilion and mucosal surfaces of the lips and tongue.
Also the facial skin and neck are also involved.
Differential diagnosis:
Petechial hemorrhages with platelet disorders.
Varix
Pathological dilatation of veins and venules
mostly common intra orally in the ventral surface of the tongue appear as tortuous blue ,red and purple elevation(
Degenerative change in adventitia of venous walls as result of aging.
Exogenous pigmentation
Black hairy tongue
Tattoo: amalgam ,graphite
Metallic intoxification
Black Hairy tongue
Amalgam Tattoo
Metallic intoxification