eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Oral Melanoacanthoma: Differential Diagnoses & Workup

Author: Talib Najjar, DMD, MDS, PhD, Professor of Oral and Maxillofacial Surgery and Pathology, University of Medicine and Dentistry of New Jersey
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; Nathan Wuebbels, DMD, MD, Staff Physician, Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry, New Jersey, University Hospital
Contributor Information and Disclosures

Updated: Oct 6, 2008

Differential Diagnoses

Seborrheic Keratosis

Other Problems to Be Considered

Melanoma in situ
Melanosis
Superficial melanoma
Junctional melanocytic nevus
Melanotic macule
Pigmented basal cell epithelioma

Workup

Procedures

  • The clinical features of cutaneous and mucosal lesions may mimic those of other pigmented lesions; therefore, definitive diagnosis is based on histologic examination.
  • Incisional or excisional biopsy may be performed based on the size and the anatomic location of the lesion.

Histologic Findings

Microscopic examination reveals a hyperplastic edematous stratified squamous epithelium with acanthosis and elongated widened rete ridges. Increased melanin pigmentation is present in the basal layer (see Media File 3). In addition, many proliferating dendritic melanocytes or clear cells extend upward into the prickle-cell layers (see Media File 4).

The clinical and histologic features of oral melanoacanthoma lesions can resemble those of melanoma in situ.18 Usually, no evidence of cellular pleomorphism or abnormal mitotic activity is seen in oral melanoacanthomas, and this feature excludes malignancy.

In mucosal lesions, mixed chronic inflammatory cells and numerous melanin-laden macrophages densely infiltrate the stratum corneum. This inflammatory process may indicate the reactive rather than the neoplastic nature of the lesion.19,20

More on Oral Melanoacanthoma

Overview: Oral Melanoacanthoma
Differential Diagnoses & Workup: Oral Melanoacanthoma
Treatment & Medication: Oral Melanoacanthoma
Follow-up: Oral Melanoacanthoma
Multimedia: Oral Melanoacanthoma
References
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References

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

  2. Wright JM, Binnie WH, Byrd DL, Dunsworth AR. Intraoral melanoacanthoma. J Periodontol. Feb 1983;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. Dec 1983;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. Nov 1988;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. Jan-Feb 2005;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. Feb 2003;25(1):12-5. [Medline].

  7. Frey VM, Lambert WC, Seldin RD, Schneider LC, Mesa ML. Intraoral melanoacanthoma. J Surg Oncol. Oct 1984;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. Sep 1 2007;12(5):E374-9. [Medline].

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

  10. Yarom N, Hirshberg A, Buchner A. Solitary and multifocal oral melanoacanthoma. Int J Dermatol. Dec 2007;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. Nov 1997;84(5):492-4. [Medline].

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

  13. Matsuoka LY, Glasser S, Barsky S. Melanoacanthoma of the lip. Arch Dermatol. Sep 1979;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. Oct 1987;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. Oct 1988;117(5):620-2. [Medline].

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

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

  18. 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. Oct 1987;26(8):508-10. [Medline].

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

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

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

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

  23. 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].

  24. Brooks JK, Nikitakis NG. Gingival pigmentation of recent origin. Oral melanoacanthoma. Gen Dent. Jan-Feb 2008;56(1):105, 108. [Medline].

  25. Zemtsov A, Bergfeld WF. Oral melanoacanthoma with prominent spongiotic intraepithelial vesicles. J Cutan Pathol. Dec 1989;16(6):365-9. [Medline].

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Further Reading

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Keywords

oral melanoacanthoma, melanoacanthoma, mucosal melanoacanthoma, mucosal lesions, cutaneous melanoacanthoma, pigmented seborrheic keratosis, melanocyte and keratinocyte proliferation, pigmented macular lesions, benign nonovoid melanoepithelioma

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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
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 and 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, and American Student Dental Association
Disclosure: Nothing to disclose.

Medical Editor

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: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center
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

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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