Approach Considerations
Generally, no treatment is necessary. However, if the pigmentation is in an unusual location, such as the hard palate; if an area of ulceration is present; or the lesion is elevated, a biopsy is necessary to exclude other pigmented conditions (eg, nevi, melanoma).
The patient should be informed regarding the harmful effects of tobacco and the different tobacco cessation modalities available, such as pharmacotherapy, counseling, and behavioral treatments. [24] Cessation of the habit can decrease the pigmentation, and patients who have quit for at least 3 years show a prevalence similar to nonsmokers. [5, 25, 26, 27] Smoking cessation is indicated for a multitude of health reasons.
Carbon dioxide lasers have been successfully used to remove gingival lesions for cosmetic reasons. [28]
Consultations
Smoking cessation programs with counselors or behavior modification specialists may be beneficial. Also see the clinical guideline summary from the US Preventive Services Task Force, Final Recommendation Statement: Tobacco Use in Adults and Pregnant Women: Counseling and Interventions. [29]
Long-Term Monitoring
Routine follow-up care is necessary to ensure that the lesion is slowly disappearing.
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Several focal brownish pigmentations of the maxillary anterior gingiva.
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Gingival biopsy of a basilar melanosis (a brownish granular pigment present along the basal cells).
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A reverse smoker with white and pigmented palatal mucosa and a focal area of erythema.
