Oral Melanoacanthoma 

  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 23, 2012
 

Background

Melanoacanthoma is a rare condition of oral mucosa that has been reported only in the last century. The lesion is characterized by a proliferation of both melanocytes and keratinocytes that results in pigmented macular or plaquelike lesions (see image below).

Diagram of a pigmented epithelial macule. Diagram of a pigmented epithelial macule.

Oral melanoacanthoma is regarded by many as a reactive condition unrelated to cutaneous melanoacanthoma, but the histologic features are similar. Cutaneous and mucosal melanoacanthoma differ in terms of patient age, patient race, and site.

In 1927, Bloch provided the earliest known description of melanoacanthoma, which was reported in the German literature.[1] Bloch described several skin lesions, which he originally called benign nonovoid melanoepithelioma of the skin. He further subdivided his cases into 2 types: In the histologic samples studied, type 1 had both dendritic melanocytes and keratinocytes, whereas the histologic appearance of type 2 was similar to that of type 1, but it lacked the dendritic melanocytes.

In 1960, Mishima and Pinkus reexamined the condition and further refined the diagnostic terminology.[2] The condition that Bloch designated as type 1 is currently called melanoacanthoma, and type 2 is currently called pigmented seborrheic keratosis.

Although cutaneous lesions of melanoacanthoma were reported as early as 1927, Tomich et al at the American Academy of Oral Pathology first reported oral mucosal lesions in 1978.[1] Although many authors subsequently published case reports, Goode et al published the first case report in 1983.[3] This was a retrospective review of 10 cases of oral melanoacanthoma reported in the literature.

To date, oral melanoacanthoma remains a rare condition, with approximately fewer than 100 reported cases. The cutaneous variant is also rare; however, it is more prevalent than the mucosal variant.

Next

Pathophysiology

The mucosal variants of melanoacanthoma have histologic appearances similar to that of cutaneous melanoacanthoma. The lesion consists of proliferating melanocytes and keratinocytes, which result in large pigment-containing dendritic cells. The dendritic cells are present throughout the middle and upper layers of the epithelium.

Inflammation occurs almost universally in patients with mucosal lesions. The presence of inflammation and the spontaneous resolution of oral lesions are suggestive of a reactive process rather than a neoplastic process. The observation of trauma and inflammation associated with oral lesions has led to the conclusion that the mucosal variant is likely the result of a reactive process rather than a neoplastic process.[4]

Previous
Next

Epidemiology

Frequency

United States

Oral melanoacanthoma is rare, with only approximately fewer than 100 cases reported since 1978,[5, 6, 7] when the lesions were first reported. The cutaneous variant is more common, but it is still relatively rare among skin lesions. Among all the cases reported, specific patterns are described with respect to the race, sex, and age of patients with cutaneous melanoacanthomas and those with mucosal melanoacanthomas.

Race

Cutaneous lesions of melanoacanthoma are reported almost exclusively in white patients. The mucosal variant is reported almost exclusively in black patients.[8, 9] Some sporadic mucosal cases are reported in Asian individuals.

Sex

The prevalence for both variants of melanoacanthoma is fairly equal in both sexes, with a slight female predominance.[10] The female-to-male ratio is approximately 3:2.

Age

The age distributions of the 2 types of melanoacanthoma differ.[11] Cutaneous lesions are found in patients with a mean age of approximately 60 years. Mucosal lesions appear in patients with a mean age of approximately 25 years.

Previous
Proceed to Clinical Presentation
 
 
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)

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.

Specialty Editor Board

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.

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

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.

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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

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

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

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. 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].

  25. Arava-Parastatidis M, Alawi F, Stoopler ET. Multifocal pigmentation of the oral cavity. Oral melanoacanthoma. J Am Dent Assoc. Jan 2011;142(1):53-6. [Medline].

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

  27. Brooks JK, Sindler AJ, Scheper MA. Oral melanoacanthoma in an adolescent. Pediatr Dermatol. Jul-Aug 2010;27(4):384-7. [Medline].

  28. Galindo-Moreno P, Padial-Molina M, Gómez-Morales M, Aneiros-Fernández J, Mesa F, O'Valle F. Multifocal oral melanoacanthoma and melanotic macula in a patient after dental implant surgery. J Am Dent Assoc. Jul 2011;142(7):817-24. [Medline].

  29. Geetha T, Rani GG, Krishnaram AS. Bilateral oral melanoacanthoma in an Indian boy. Indian J Dermatol Venereol Leprol. Mar-Apr 2011;77(2):210-2. [Medline].

  30. Lakshminarayanan V, Ranganathan K. Oral melanoacanthoma: a case report and review of the literature. J Med Case Rep. Jan 13 2009;3:11. [Medline]. [Full Text].

  31. Tapia JL, Quezada D, Gaitan L, Hernandez JC, Paez C, Aguirre A. Gingival melanoacanthoma: case report and discussion of its clinical relevance. Quintessence Int. Mar 2011;42(3):253-8. [Medline].

 
Previous
Next
 
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).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.