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Oral Melanoacanthoma Clinical Presentation

  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 19, 2016
 

History

Because the lesions of oral melanoacanthoma are not painful, physicians usually discover them on routine oral examination.

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Physical

The clinical features of oral melanoacanthoma may mimic those of other pigmented lesions. For example, the clinical and histologic features of oral melanoacanthoma lesions can resemble those of melanoma in situ.

Cutaneous lesions are as follows:

  • Cutaneous lesions are reported in the scalp, eyelid, ear, nose, neck, thorax, and abdomen.
  • Cutaneous lesions may be found on any area of the head and neck, as well as on the chest, abdomen, back, or legs.
  • The lesions are generally asymptomatic, flat or slightly raised hyperpigmented areas.
  • The color of the lesions ranges from brown to black to blue.
  • Lesions are usually isolated, with no apparent precipitating factors.
  • Lesions are slow growing and are usually present for months before treatment is sought.

Mucosal lesions are as follows:

  • Mucosal lesions can occur in the buccal mucosa, labial mucosa, palate, gingiva (see image below),[12] alveolar ridge, or lip.[13, 14]
    Intraoral melanoacanthoma lesion on the mandibularIntraoral melanoacanthoma lesion on the mandibular gingiva.
  • Although the appearance of mucosal lesions is similar to that of cutaneous lesions, mucosal lesions have a more rapid onset and rate of growth.[15]
  • Mucosal lesions occur mostly on the lip,[16] buccal mucosa,[17] or palate,[18] and they are precipitated by a traumatic event.
  • The diameter of the mucosal lesions can range from a few millimeters to several centimeters.
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Causes

The role of trauma in the development of the lesion remains controversial, but any irritant must be removed. BRAF inhibitor therapy may play a role in some cases.[19]

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Contributor Information and Disclosures
Author

Talib Najjar, DMD, MDS, PhD Professor of Oral and Maxillofacial Surgery and Pathology, Rutgers School of Dental Medicine

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

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas A Chiodo, DDS Staff Dentist, Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry of New Jersey; Private Practice, Oral and Maxillofacial Surgery

Thomas A Chiodo, DDS is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association

Disclosure: Nothing to disclose.

Nathan Wuebbels, DMD, MD Staff Physician, Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry, New Jersey, University Hospital

Nathan Wuebbels, DMD, MD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association, American Student Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Neil Shear, MD Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

References
  1. Schneider LC, Mesa ML, Haber SM. Melanoacanthoma of the oral mucosa. Oral Surg Oral Med Oral Pathol. 1981 Sep. 52(3):284-7. [Medline].

  2. Wright JM, Binnie WH, Byrd DL, Dunsworth AR. Intraoral melanoacanthoma. J Periodontol. 1983 Feb. 54(2):107-11. [Medline].

  3. Goode RK, Crawford BE, Callihan MD, Neville BW. Oral melanoacanthoma. Review of the literature and report of ten cases. Oral Surg Oral Med Oral Pathol. 1983 Dec. 56(6):622-8. [Medline].

  4. Horlick HP, Walther RR, Zegarelli DJ, Silvers DN, Eliezri YD. Mucosal melanotic macule, reactive type: a simulation of melanoma. J Am Acad Dermatol. 1988 Nov. 19(5 Pt 1):786-91. [Medline].

  5. Contreras E, Carlos R. Oral melanoacanthosis (melanoachantoma): report of a case and review of the literature. Med Oral Patol Oral Cir Bucal. 2005 Jan-Feb. 10(1):11-2; 9-11. [Medline].

  6. Fornatora ML, Reich RF, Haber S, Solomon F, Freedman PD. Oral melanoacanthoma: a report of 10 cases, review of the literature, and immunohistochemical analysis for HMB-45 reactivity. Am J Dermatopathol. 2003 Feb. 25(1):12-5. [Medline].

  7. Frey VM, Lambert WC, Seldin RD, Schneider LC, Mesa ML. Intraoral melanoacanthoma. J Surg Oncol. 1984 Oct. 27(2):93-6. [Medline].

  8. Carlos-Bregni R, Contreras E, Netto AC, Mosqueda-Taylor A, Vargas PA, Jorge J, et al. Oral melanoacanthoma and oral melanotic macule: a report of 8 cases, review of the literature, and immunohistochemical analysis. Med Oral Patol Oral Cir Bucal. 2007 Sep 1. 12(5):E374-9. [Medline].

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

  10. Yarom N, Hirshberg A, Buchner A. Solitary and multifocal oral melanoacanthoma. Int J Dermatol. 2007 Dec. 46(12):1232-6. [Medline].

  11. Chandler K, Chaudhry Z, Kumar N, Barrett AW, Porter SR. Melanocanthoma: a rare cause of oral hyperpigmentation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Nov. 84(5):492-4. [Medline].

  12. Flaitz CM. Oral melanoacanthoma of the attached gingiva. Am J Dent. 2000 Jun. 13(3):162. [Medline].

  13. Matsuoka LY, Glasser S, Barsky S. Melanoacanthoma of the lip. Arch Dermatol. 1979 Sep. 115(9):1116-7. [Medline].

  14. Sexton FM, Maize JC. Melanotic macules and melanoacanthomas of the lip. A comparative study with census of the basal melanocyte population. Am J Dermatopathol. 1987 Oct. 9(5):438-44. [Medline].

  15. Whitt JC, Jennings DR, Arendt DM, Vinton JR. Rapidly expanding pigmented lesion of the buccal mucosa. J Am Dent Assoc. 1988 Oct. 117(5):620-2. [Medline].

  16. Muco-cutaneous Keratoacanthoma Involving Maxillary Lip. Mattoo KA, Singh M, Singh V. Oral Surg Oral Med Oral Rad. 2014. 2(2):20-21. [Full Text].

  17. Fatahzadeh M, Sirois DA. Multiple intraoral melanoacanthomas: a case report with unusual findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jul. 94(1):54-6. [Medline].

  18. Buchner A, Merrell PW, Carpenter WM. Relative frequency of solitary melanocytic lesions of the oral mucosa. J Oral Pathol Med. 2004 Oct. 33(9):550-7. [Medline].

  19. Boussemart L, Girault I, Malka-Mahieu H, Mateus C, Routier E, Rubington M, et al. Secondary Tumors Arising in Patients Undergoing BRAF Inhibitor Therapy Exhibit Increased BRAF-CRAF Heterodimerization. Cancer Res. 2016 Mar 15. 76 (6):1476-84. [Medline].

  20. Sen S, Samanta A, Majumdar B, Jain A, Behra A, Mishra P. "Nevoid Eruptive Keratoacanthoma" - Yet Another Atypical Manifestation of Generalized Keratoacanthoma. Indian J Dermatol. 2016 Jan-Feb. 61 (1):106-7. [Medline].

  21. Kanzaki A, Kudo M, Ansai S, Peng WX, Ishino K, Yamamoto T, et al. Insulin-like growth factor 2 mRNA-binding protein-3 as a marker for distinguishing between cutaneous squamous cell carcinoma and keratoacanthoma. Int J Oncol. 2016 Mar. 48 (3):1007-15. [Medline].

  22. Lambert WC, Lambert MW, Mesa ML, Schnieder LC, Fischman GJ, Abbey AH, et al. Melanoacanthoma and related disorders. Simulants of acral-lentiginous (P-P-S-M) melanoma. Int J Dermatol. 1987 Oct. 26(8):508-10. [Medline].

  23. Wright JM. Intraoral melanoacanthoma: a reactive melanocytic hyperplasia. Case report. J Periodontol. 1988 Jan. 59(1):53-5. [Medline].

  24. Krahl D, Altenburg A, Zouboulis CC. Reactive hyperplasias,precancerous and malignant lesions of the oral mucosa. J Dtsch Dermatol Ges. 2008 Mar. 6(3):217-32. [Medline].

  25. Heine BT, Drummond JF, Damm DD, Heine RD 2nd. Bilateral oral melanoacanthoma. Gen Dent. 1996 Sep-Oct. 44(5):451-2. [Medline].

  26. Andrews BT, Trask DK. Oral melanoacanthoma: a case report, a review of the literature, and a new treatment option. Ann Otol Rhinol Laryngol. 2005 Sep. 114(9):677-80. [Medline].

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Diagram of a pigmented epithelial macule.
Intraoral melanoacanthoma lesion on the mandibular gingiva.
Increased melanin pigmentation in the basal layer of a melanoacanthoma (hematoxylin and eosin, original magnification X10).
Proliferating dendritic melanocytes in the prickle-cell layers of a melanoacanthoma (hematoxylin and eosin, original magnification X40).
 
 
 
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