Smoker's Melanosis Clinical Presentation

  • Author: William M Carpenter, DDS, MS; Chief Editor: William D James, MD   more...
 
Updated: Jan 18, 2012
 

History

No symptoms are associated with smoker's melanosis. A smoking history is needed to substantiate the diagnosis.

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Physical

Smoker's melanosis is a brownish discoloration of the oral mucosa. In cigarette smokers, most lesions are located on the mandibular anterior gingiva. Pipe smokers more frequently display pigmentation of the buccal mucosa. In people who engage in reverse smoking (ie, the lit end of a cigarette placed in the oral cavity), pigmentation of the hard palate is common. If the areas become depigmented and erythematous, squamous cell carcinoma has been found in 12% of these patients.[8]

Several focal brownish pigmentations of the maxillSeveral focal brownish pigmentations of the maxillary anterior gingiva. A reverse smoker with white and pigmented palatal A reverse smoker with white and pigmented palatal mucosa and a focal area of erythema.
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Causes

Smoker's melanosis is likely due to direct effects of tobacco smoke on the oral mucosa. Smoke is thought to cause changes in the mucosa through a combination of physical (heat) and/or chemical (nicotine) effects. Individuals using smokeless tobacco or nicotine-containing gum do not develop this condition. Also see Cutaneous Manifestations of Smoking and Smokeless Tobacco Lesions.

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Contributor Information and Disclosures
Author

William M Carpenter, DDS, MS  Professor, Chairman, Department of Pathology and Medicine, University of the Pacific Arthur A Dugoni School of Dentistry

William M Carpenter, DDS, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and American Academy of Oral Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

R Stan Taylor, MD  The JB Howell Professor in Melanoma Education and Detection, Departments of Dermatology and Plastic Surgery, Director, Skin Surgery and Oncology Clinic, University of Texas Southwestern Medical Center

R Stan Taylor, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, Christian Medical & Dental Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Dana Gelman Keiles, DMD, to the development and writing of this article.

References

  1. Hedin CA. Smokers' melanosis. Occurrence and localization in the attached gingiva. Arch Dermatol. Nov 1977;113(11):1533-8. [Medline].

  2. Axéll T, Hedin CA. Epidemiologic study of excessive oral melanin pigmentation with special reference to the influence of tobacco habits. Scand J Dent Res. Dec 1982;90(6):434-42. [Medline].

  3. Hedin CA, Axéll T. Oral melanin pigmentation in 467 Thai and Malaysian people with special emphasis on smoker's melanosis. J Oral Pathol Med. Jan 1991;20(1):8-12. [Medline].

  4. Nwhator SO, Winfunke-Savage K, Ayanbadejo P, Jeboda SO. Smokers' melanosis in a Nigerian population: a preliminary study. J Contemp Dent. Pract. Jul 2007;8(5):68-75. [Medline].

  5. Mehrotra R, Thomas S, Nair P, Pandya S, Singh M, Nigam NS, et al. Prevalence of oral soft tissue lesions in Vidisha. BMC Res Notes. Jan 25 2010;3:23. [Medline]. [Full Text].

  6. Marakoglu K, Gursoy, UK, Toker, HC, Demirer S, et al. Smoking status and smoke-related gingival melanin pigmentation in army recruitments. Mil Med. Jan 2007;172:110-3. [Medline].

  7. Brown FH, Houston GD. Smoker's melanosis. A case report. J Periodontol. Aug 1991;62(8):524-7. [Medline].

  8. Hedin C, Pindborg JJ, Daftary DK, Mehta FS. Melanin depigmentation of the palatal mucosa in reverse smokers: a preliminary study. J Oral Pathol Med. Nov 1992;21(10):440-4. [Medline].

  9. Hedin CA, Pindborg JJ, Axéll T. Disappearance of smoker's melanosis after reducing smoking. J Oral Pathol Med. May 1993;22(5):228-30. [Medline].

  10. [Guideline] US Preventive Services Task Force. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. Apr 21 2009;150(8):551-5. [Medline].

  11. Neville BW. Smoker's Melanosis. In: Neville BW, Damm DD, Allen CM, and Bouquot JE, eds. Oral & Maxillofacial Pathology. 3rd ed. Philadelphia, Pa: WB Saunders; 2002:316-17.

  12. Taybos G. Oral changes associated with tobacco use. Am J Med Sci. Oct 2003;326(4):179-82. [Medline].

 
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Several focal brownish pigmentations of the maxillary anterior gingiva.
Gingival biopsy of a basilar melanosis (a brownish granular pigment present along the basal cells).
A reverse smoker with white and pigmented palatal mucosa and a focal area of erythema.
 
 
 
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