Oral Nevi Clinical Presentation

Updated: Dec 15, 2017
  • Author: Kara Melissa T Torres, MD, DPDS; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Most oral nevi are solitary and asymptomatic. Congenital melanocytic nevi are present at birth or appear shortly after. Acquired melanocytic nevi begin to appear in early childhood. The lesions are usually detected as an incidental finding on routine dental examination.

Of patients with recorded complaints, 22% described a mass, growth, or pigmented spot. [35] A minority of patients complained of soreness or pain related to another cause, such as an ill-fitting denture. Less than 1 in 10 patients were aware of evolving lesions. Most patients could only speculate about the duration of their condition.

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Physical Examination

Benign oral nevi present as asymptomatic, well circumscribed, round or oval macules or papules with smooth surface that range in color from light brown to black. [36] These lesions may rarely present as epulislike swelling of the gingiva and as a hamartoma on the palate, composed of nevus cells, hyperplastic salivary gland tissue, adipose tissue, nerves, and vessels. [37, 38] Oral nevi usually occur as solitary lesions; however, one case of multiple intraoral nevi has been described in the literature. [39] Intramucosal nevi and rarely Spitz nevi may be nonpigmented or amelanotic 15-22% of the time and present as sessile growths that resemble fibromas or papillomas. [7, 35, 38]

The average size of an oral nevus is 0.3-0.5 cm at the largest diameter. [29, 30] Blue nevi are smaller than intramucosal nevi. Larger nevi (>6 mm) are more likely to be congenital.

Intraoral melanocytic nevi most commonly occur on the hard palate, followed by the buccal mucosa. Rarely, the tongue, floor of the mouth, [6, 40] and pharynx may be involved. [21] The distribution varies depending on the histologic type of the nevus. The hard palate is the most common location for blue nevi. [3, 41] The hard palate, buccal mucosa, gingiva, and lips are common locations for intramucosal nevi. [35] See the images below.

Intramucosal nevus on the lower lip. This brown pa Intramucosal nevus on the lower lip. This brown papule measured 0.6 cm in diameter and was only slightly raised. Melanotic macules are invariably flat.
Blue nevus on the gingiva. This 1-cm saucer-shaped Blue nevus on the gingiva. This 1-cm saucer-shaped tan macule on the gingiva has histologic features consistent with those of a blue nevus, which is the second most common type of oral nevus. This location is atypical because most blue nevi occur on the palate.

Oral nevi may be mistaken for other pigmented lesions in the oral cavity secondary to endogenous and exogenous causes. Certain clinical features can assist clinicians in making the correct diagnosis. [42, 43] Melanotic macules and amalgam tattoos are usually flat and 80% of nevi are elevated. Ethnic pigmentation is nearly always symmetric and rarely affects the surface topography or disturbs the normal stippling in the gingiva. Smoker's melanosis involves only the anterior gingiva, and, of course, a history of smoking is essential. Vascular lesions usually blanch with compression and melanocytic proliferations do not. Malignant melanoma is frequently associated with diffuse areas of pigmentation, possible ulceration, nodularity, variegation in color, and an irregular outline.

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