Disorders of Oral Pigmentation Follow-up

  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: William D James, MD   more...
 
Updated: May 23, 2012
 

Further Outpatient Care

  • Peutz-Jeghers syndrome: Close follow-up care is needed for the GI aspects of the disease. Genetic counseling should be offered to families trying to have children. Further outpatient care for patients with Peutz-Jeghers syndrome includes the following:
    • Annual physical examination that includes evaluation of the breasts, the abdomen, the pelvis, and the testes
    • Annual complete blood cell count
    • Repeated removal of hemorrhagic or large polyps (>5 mm) by endoscopic polypectomy
    • Surveillance for cancer, possibly including the following:
      • Small intestine with small bowel radiography every 2 years
      • Esophagogastroduodenoscopy and colonoscopy every 2 years
      • Ultrasonography of the pancreas yearly
      • Ultrasonography of the pelvis (women) and testes (men) yearly
      • Mammography (women) at ages 25, 30, 35, and 38 years; every 2 years until age 50 years; then annually
      • Papanicolaou (Pap) test every 3 years
  • Amalgam tattoos: No follow-up care is necessary for amalgam tattoos once the diagnosis is determined.
  • Melanoma
    • Patients with melanoma must receive close follow-up care involving oncologists, surgical oncologists, radiologists, and dermatologists.
    • In many instances, psychological assistance and intervention is also necessary.
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Complications

  • Peutz-Jeghers syndrome
    • In young patients, small intestinal obstruction and intussusception are the main complications. These complications result from the small intestinal location of the polyps.
    • Cancer is the main consequence as patients with Peutz-Jeghers syndrome age (93% cumulative risk by age 64 y). The major sites of cancer occurrence (in order of risk) are the small intestine, the stomach, the pancreas, the colon, the esophagus, the ovaries, the lungs, the uterus, and the breasts. In addition, other reproductive site cancers have been associated with Peutz-Jeghers syndrome, including adenoma malignum of the cervix, Sertoli cell tumors, and sex cord tumors with annular tubules.
  • Amalgam tattoos: No major complications are reported.
  • Melanoma
    • Complications stem from the loss of anatomic structures as a result of the surgical procedure.
    • Interferon use is associated with malaise, flulike symptoms, fever, and myalgia.
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Prognosis

  • Peutz-Jeghers syndrome: Approximately 48% of patients with Peutz-Jeghers syndrome develop and die from cancer by age 57 years.
  • Amalgam tattoos: The prognosis for patients with amalgam tattoos is excellent because the condition is not associated with any sequelae.
  • Melanoma
    • The prognosis for patients with oral malignant melanoma is relatively dismal. Early recognition and treatment greatly improves the prognosis.
    • Late discovery and diagnosis often indicate the existence of an extensive tumor with metastasis. After surgical ablation, recurrence and metastasis are frequent events, and most patients die of the disease in 2 years. A review of the literature indicates that the 5-year survival rate is within a broad range of 4.5-48%, but a large cluster occurs at 10-25%. The best option for survival is the prevention of metastasis by surgical excision of the tumor. Eneroth and Lundberg[6] state that patients are not cured of oral melanoma and that the risk of death always exists. Long periods of remission may be punctuated by recurrence.
    • In one large study (1074 cases of mucosal melanomas), when lymph node status was known, 30% of patients with mucosal melanomas had positive nodes. When lymph node metastasis occurs, the prognosis worsens precipitously. For instance, the 5-year survival rate in patients with positive nodes is 16.4%, compared with 38.7% in patients with negative nodes.
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Patient Education

  • Patients with Peutz-Jeghers syndrome should be educated on the potential symptoms of intestinal obstruction and instructed on the need for cancer surveillance.
  • Reassurance is all that is necessary for patients with amalgam tattoos.
  • Patients with melanoma should learn how to perform an effective oral examination.
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Contributor Information and Disclosures
Author

Talib Najjar, DMD, MDS, PhD  Professor of Oral and Maxillofacial Surgery and Pathology, University of Medicine and Dentistry of New Jersey

Talib Najjar, DMD, MDS, PhD is a member of the following medical societies: American Society for Clinical Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

Brian J Dorfman, DMD, MD  Staff Physician, Department of Oral and Maxillofacial Surgery, University Hospital, University of Medicine and Dentistry of New Jersey

Brian J Dorfman, DMD, MD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

James Fulton Jr, MD, PhD  Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC

James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation

Disclosure: Vivant Pharmaceuticals Grant/research funds Consulting

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

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

References

  1. Boardman LA, Thibodeau SN, Schaid DJ, Lindor NM, McDonnell SK, Burgart LJ, et al. Increased risk for cancer in patients with the Peutz-Jeghers syndrome. Ann Intern Med. Jun 1 1998;128(11):896-9. [Medline].

  2. Giardiello FM, Welsh SB, Hamilton SR, Offerhaus GJ, Gittelsohn AM, Booker SV, et al. Increased risk of cancer in the Peutz-Jeghers syndrome. N Engl J Med. Jun 11 1987;316(24):1511-4. [Medline].

  3. Jenne DE, Reimann H, Nezu J, Friedel W, Loff S, Jeschke R, et al. Peutz-Jeghers syndrome is caused by mutations in a novel serine threonine kinase. Nat Genet. Jan 1998;18(1):38-43. [Medline].

  4. Kirkwood JM, Resnick GD, Cole BF. Efficacy, safety, and risk-benefit analysis of adjuvant interferon alfa-2b in melanoma. Semin Oncol. Feb 1997;24(1 Suppl 4):S16-23. [Medline].

  5. McKinnon JG, Kokal WA, Neifeld JP, Kay S. Natural history and treatment of mucosal melanoma. J Surg Oncol. Aug 1989;41(4):222-5. [Medline].

  6. Eneroth CM, Lundberg C. Mucosal malignant melanomas of the head and neck with special reference to cases having a prolonged clinical course. Acta Otolaryngol. Nov-Dec 1975;80(5-6):452-8. [Medline].

  7. Borden EC. Melanoma and pregnancy. Semin Oncol. Dec 2000;27(6):654-6. [Medline].

  8. Achar A, Rathi SK. Melasma: a clinico-epidemiological study of 312 cases.Achar A, Rathi SK.Indian J Dermatol. 2011 Jul;56(4):380-2.PMID: 21965843 [PubMed]. Indian J Dermatol. jul2011;4:280-2. [Medline].

  9. Allen CM, Pellegrini A. Probable congenital melanocytic nevus of the oral mucosa: case report. Pediatr Dermatol. Jun 1995;12(2):145-8. [Medline].

  10. Auluck A, Zhang L, Desai R, Rosin MP. Primary malignant melanoma of maxillary gingiva--a case report and review of the literature. J Can Dent Assoc. May 2008;74(4):367-71. [Medline].

  11. 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].

  12. Barnes L. Oral mucosal malignant melanoma. In: Surgical Pathology of the Head and Neck. 2nd ed. New York, NY: Marcel Decker; 2001:410-38.

  13. Bessa CF, Santos PJ, Aguiar MC, do Carmo MA. Prevalence of oral mucosal alterations in children from 0 to 12 years old. J Oral Pathol Med. Jan 2004;33(1):17-22. [Medline].

  14. Bouquot JE. Common oral lesions found during a mass screening examination. J Am Dent Assoc. Jan 1986;112(1):50-7. [Medline].

  15. Brasil Cda M, Ribeiro CM, Fonseca DD, Gueiros LA, Leao JC. Chloroquine-induced hyperpigmentation of the hard palate. Gen Dent. Mar-Apr 2012;60(2):e74-8. [Medline].

  16. Brooks JK, Reynolds MA. Ethnobotanical tattooing of the gingiva: literature review and report of a case. J Am Dent Assoc. Aug 2007;138(8):1097-101. [Medline].

  17. Buchner A, Hansen LS. Pigmented nevi of the oral mucosa: a clinicopathologic study of 36 new cases and review of 155 cases from the literature. Part II: Analysis of 191 cases. Oral Surg Oral Med Oral Pathol. Jun 1987;63(6):676-82. [Medline].

  18. Carpenter WM, Rudd M. Focal, flat pigmentations of the oral mucosa: a clinical approach to the differential diagnosis. J Calif Dent Assoc. Dec 2000;28(12):949-54. [Medline].

  19. Collins B, Abernethy J, Barnes L. Oral Malignant Melanoma. eMedicine from WebMD [serial online]. November 8, 2006;Available at http://emedicine.medscape.com/article/1078833-overview.

  20. de Araújo PI, Soares VY, Queiroz AL, Santos AM, Nascimento LA. Sarcomatous transformation in the McCune-Albright syndrome. Oral Maxillofac Surg. Sep 3 2011;[Medline].

  21. De Giorgi V, Sestini S, Bruscino N, Janowska A, Grazzini M, Rossari S, et al. Prevalence and distribution of solitary oral pigmented lesions: a prospective study. J Eur Acad Dermatol Venereol. Nov 2009;23(11):1320-3. [Medline].

  22. de Melo Filho MR, da Silva CA, da Rocha et al. Palate hyperpigmentation caused by prolonged use of the anti-malarial chloroquine. Head Neck Pathol. Mar 2012;6(1):48-50. [Medline]. [Full Text].

  23. Duchini A, Carethers JM. Peutz-Jeghers Syndrome. eMedicine from WebMD [serial online]. January 4, 2007;Available at http://emedicine.medscape.com/article/182006-overview.

  24. Eisen D, Voorhees JJ. Oral melanoma and other pigmented lesions of the oral cavity. J Am Acad Dermatol. Apr 1991;24(4):527-37. [Medline].

  25. Elder DE, Clark WH Jr, Elenitsas R, Guerry D 4th, Halpern AC. The early and intermediate precursor lesions of tumor progression in the melanocytic system: common acquired nevi and atypical (dysplastic) nevi. Semin Diagn Pathol. Feb 1993;10(1):18-35. [Medline].

  26. Fischer R, Breidert M, Paul S, Kreisel W, Schmitt-Gräff A, Waller C, et al. [A patient with chronic diarrhoe, head pigmentation and alopecia. Cronkhite-Canada syndrome]. Dtsch Med Wochenschr. Feb 2010;135(8):339-42. [Medline].

  27. Georgescu EF, Stanescu L, Simionescu C, Georgescu I, Ionescu R, Florescu G. Peutz-Jeghers syndrome: case report and literature review. Rom J Morphol Embryol. 2008;49(2):241-5. [Medline].

  28. Gollnick A. Malignant melanoma of the oral mucosa. In: Oral Diseases: Textbook and Atlas. Berlin, Germany: Springer-Verlag; 1999:327-31.

  29. 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. May 1 2012;[Medline].

  30. Higham P, Alawi F, Stoopler ET. Medical management update: Peutz Jeghers syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jan 2010;109(1):5-11. [Medline].

  31. Hussaini HM, Waddell JN, Girvan L, et al. Silver solder "tattoo," a novel form of oral pigmentation identified with the use of field emission scanning electron microscopy and electron dispersive spectrography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Oct 2011;112(4):e6-10. [Medline].

  32. Jeghers H, McKusick VA, Katz KH. Generalized intestinal polyposis and melanin spots of the oral mucosa, lips and digits; a syndrome of diagnostic significance. N Engl J Med. Dec 22 1949;241(25):993, illust; passim. [Medline].

  33. Kahn MA, Weathers DR, Hoffman JG. Transformation of a benign oral pigmentation to primary oral melanoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Oct 2005;100(4):454-9. [Medline].

  34. Kathariya R, Pradeep AR. Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature. J Indian Soc Periodontol. Apr 2011;15(2):161-8. [Medline]. [Full Text].

  35. Kauh YC, Zachian TF. Melasma. Adv Exp Med Biol. 1999;455:491-9. [Medline].

  36. Kerr EH, Hameed O, Lewis JS Jr, Bartolucci AA, Wang D, Said-Al-Naief N. Head and neck mucosal malignant melanoma: clinicopathologic correlation with contemporary review of prognostic indicators. Int J Surg Pathol. Feb 2012;20(1):37-46. [Medline].

  37. Lampe AK, Hampton PJ, Woodford-Richens K, Tomlinson I, Lawrence CM, Douglas FS. Laugier-Hunziker syndrome: an important differential diagnosis for Peutz-Jeghers syndrome. J Med Genet. Jun 2003;40(6):e77. [Medline].

  38. Lau JC, Jackson-Boeters L, Daley TD, Wysocki GP, Cherian MG. Metallothionein in human gingival amalgam tattoos. Arch Oral Biol. Nov 2001;46(11):1015-20. [Medline].

  39. Lenane P, Powell FC. Oral pigmentation. J Eur Acad Dermatol Venereol. Nov 2000;14(6):448-65. [Medline].

  40. Magremanne M, Vervaet C. [Melanoma of the oral mucosa]. Rev Stomatol Chir Maxillofac. Jun 2008;109(3):175-7. [Medline].

  41. Manganaro AM, Hammond HL, Dalton MJ, Williams TP. Oral melanoma: case reports and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Dec 1995;80(6):670-6. [Medline].

  42. 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. May 2008;105(5):606-16. [Medline].

  43. 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. Jan 1999;5(1):80-6. [Medline].

  44. Mowad CM, Shrager J, Elenitsas R. Oral pigmentation representing Laugier-Hunziker syndrome. Cutis. Jul 1997;60(1):37-9. [Medline].

  45. Neville BW, Damm DD, Allen CM. Oral and Maxillofacial Pathology. Philadelphia, Pa: WB Saunders; 1995.

  46. Ozog DM, Gogstetter DS, Scott G, Gaspari AA. Minocycline-induced hyperpigmentation in patients with pemphigus and pemphigoid. Arch Dermatol. Sep 2000;136(9):1133-8. [Medline].

  47. Ranganathan K, Reddy BV, Kumarasamy N, Solomon S, Viswanathan R, Johnson NW. Oral lesions and conditions associated with human immunodeficiency virus infection in 300 south Indian patients. Oral Dis. May 2000;6(3):152-7. [Medline].

  48. Scully C, Porter S. Orofacial disease: update for the dental clinical team: 4. Red, brown, black and bluish lesions. Dent Update. May 1999;26(4):169-73. [Medline].

  49. Siponen M, Salo T. Idiopathic lenticular mucocutaneous pigmentation (Laugier-Hunziker syndrome): a report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Sep 2003;96(3):288-92. [Medline].

  50. Terezhalmy GT. Clinical images in oral medicine. Amalgam tattoos. Quintessence Int. Feb 2006;37(2):152-3. [Medline].

  51. Tomich CE, Zunt SL. Melanoacanthosis (melanoacanthoma) of the oral mucosa. J Dermatol Surg Oncol. Mar 1990;16(3):231-6. [Medline].

  52. 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. Jun 2004;97(6):718-25. [Medline].

  53. Venclíkova Z, Benada O, Bártova J, Joska L, Mrklas L. Metallic pigmentation of human teeth and gingiva: morphological and immunological aspects. Dent Mater J. Jan 2007;26(1):96-104. [Medline].

  54. Westerman AM, Entius MM, de Baar E, Boor PP, Koole R, van Velthuysen ML, et al. Peutz-Jeghers syndrome: 78-year follow-up of the original family. Lancet. Apr 10 1999;353(9160):1211-5. [Medline].

  55. Zuo YG, Ma DL, Jin HZ, Liu YH, Wang HW, Sun QN. Treatment of Laugier-Hunziker syndrome with the Q-switched alexandrite laser in 22 Chinese patients. Arch Dermatol Res. Mar 2010;302(2):125-30. [Medline].

 
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Smoker melanosis.
Smoker melanosis.
Melanotic macule.
Melanotic macule.
Melanotic macule.
Oral nevi
Intramucosal nevus.
Blue nevus.
Intramucosal nevus.
Junctional nevus.
Compound nevus.
Blue nevus.
Oral pigmentation of the gingiva due to amalgam tattoo along with photomicrograph.
Photo of oral pigmented lesion from a patient with Peutz-Jeghers syndrome.
Photos of patients with amalgam tattoo.
 
 
 
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