eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Oral Nevi: Follow-up

Author: Donald Cohen, DMD, MS, Professor of Oral and Maxillofacial Pathology, Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, University of Florida College of Dentistry
Coauthor(s): Indraneel Bhattacharyya, DDS, MSD, Assistant Professor, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Director of Oral Maxillofacial Pathology Residency Program, University of Florida, College of Dentistry
Contributor Information and Disclosures

Updated: Jan 13, 2009

Follow-up

Deterrence/Prevention

  • Because oral nevi are not related to sun exposure, they are impossible to prevent.

Complications

  • Complications may be related to treatment by means of simple excision.
    • These complications may be minor.
    • Only one case of recurrent nevus in the oral cavity is reported.
  • Congenital and dysplastic nevi have an increased risk for transformation to cutaneous malignant melanoma, but these nevi are rare or absent in the mouth.
    • In one study, Buchner and Leider described 2 oral lesions that were suggestive of congenital nevi.11
    • At least 2 additional case reports have described congenital nevi in the mouth. Some of the nevi were large and certainly of concern, yet no documented case of malignant transformation has been reported.
    • No cases of dysplastic nevi were found in more than 200 reports of oral nevi in the literature. One patient with dysplastic nevus syndrome reportedly developed an oral melanoma. In this patient, the biopsy specimen demonstrated atypical melanocytic hyperplasia and not a dysplastic nevus precursor.

Prognosis

  • The prognosis of oral nevi is excellent. A few patients have had multiple nevi, including multiple junctional nevi; however, to the authors' knowledge, none of the lesions has undergone malignant transformation.
    • Although congenital nevi in the oral cavity have been reported, they are extremely rare. None has been documented as having undergone malignant transformation.
    • Dysplastic nevi in the oral cavity have not been reported.
    • One patient with dysplastic nevus syndrome developed oral atypical melanocytic hyperplasia and melanoma in situ.
    • Patients with this condition should be carefully monitored with regular oral examinations.
  • The definitive precursor lesion for mucosal melanoma has not been identified; however, in several patients, associated pigmentation was present prior to the development of mucosal melanoma.
    • Most often, the pigment was found to be atypical melanocytic hyperplasia, but benign pigmentation has been described in association with mucosal melanoma.
    • The lack of atypical features in the latter cases was attributed to sampling error.
    • A benign phase of melanocytic hyperplasia may precede the development of melanoma in the oral cavity.
  • Early diagnosis may improve the extremely poor prognosis associated with melanoma of the oral cavity.

Patient Education

  • Instruct patients to watch for pigmented lesions in the oral cavity.
  • If one or more lesions are present, advise patients to watch for changes in the border outline, that is, a change from a discrete and/or round border to an irregular border.
  • Patients should watch for and report increasing size, nodularity, ulceration, or changes in the color of their oral nevi.

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis is a potential problem.
    • Because junctional nevi account for only 3% of oral nevi, that diagnosis should be made only after confirmation at biopsy.
    • At least one case initially diagnosed as an oral junctional nevus was subsequently shown to be atypical melanocytic hyperplasia. Atypical melanocytic hyperplasia may be subtle in oral lesions, and the potential exists for histologic misinterpretation of a melanoma in situ or atypical melanocytic hyperplasia as a junctional nevus. Junctional nevi are rare in the oral cavity; therefore, this diagnosis should always be reviewed.
    • A few cases of oral melanoma in situ misdiagnosed as junctional nevi have been reported. Even patients with so-called benign mucosal melanosis should be regularly observed, and repeat biopsy should be performed if the lesions change.
  • Any oral pigmented lesion that recurs should be viewed with a high degree of suspicion.

Special Concerns

  • Pregnancy is known to exacerbate pigmentary changes in the oral cavity.
  • Patients with oral pigmented lesions should be observed during and after their pregnancy.
  • If pigmentary changes progress after a pregnancy, biopsy is recommended.
 


More on Oral Nevi

Overview: Oral Nevi
Differential Diagnoses & Workup: Oral Nevi
Treatment & Medication: Oral Nevi
Follow-up: Oral Nevi
Multimedia: Oral Nevi
References
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Further Reading

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Keywords

oral melanocytic nevus, nevocellular nevus, mole, pigmented nevus, intralamina propria nevus, intramucosal nevus, oral nevus, oral melanocytic nevi, nevocellular nevi, pigmented nevi, benign proliferation, nevus cells, hamartomas, mucosal melanocytic nevi

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Contributor Information and Disclosures

Author

Donald Cohen, DMD, MS, Professor of Oral and Maxillofacial Pathology, Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, University of Florida College of Dentistry
Donald Cohen, DMD, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology
Disclosure: Nothing to disclose.

Coauthor(s)

Indraneel Bhattacharyya, DDS, MSD, Assistant Professor, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Director of Oral Maxillofacial Pathology Residency Program, University of Florida, College of Dentistry
Indraneel Bhattacharyya, DDS, MSD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and American Dental Association
Disclosure: Nothing to disclose.

Medical Editor

Michelle Pelle, MD, Clinical Assistant Professor, Division of Dermatology, Department of Medicine, University of California at San Diego
Michelle Pelle, MD is a member of the following medical societies: American Academy of Dermatology, California Medical Association, Medical Dermatology Society, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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
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: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

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.

CME Editor

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, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
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; american college of physicians Honoraria Other

 
 
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