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.^[44]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.^{[45, 46]}Oral nevi usually occur as solitary lesions; however, one case of multiple intraoral nevi has been described in the literature.^[47]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, 33, 46]}

The average size of an oral nevus is 0.3-0.5 cm at the largest diameter.^{[38, 39]}Blue nevi are smaller than intramucosal nevi. Larger nevi (>6 mm) are more likely to be congenital.

In a retrospective analysis of 761 lesions, the most commonly involved area was the hard palate and buccal mucosa.^[29]Rarely, the tongue, floor of the mouth,^{[6, 48]}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, 49]}The hard palate, buccal mucosa, gingiva, and lips are common locations for intramucosal nevi.^[33]See the images below.

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.

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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.

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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.^{[50, 51]}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.

Differential Diagnoses

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Media Gallery

This biopsy-proven intramucosal nevus on the gingiva is unusual because it is not raised and has an irregular outline.
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 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.

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Author

Kara Melissa Torres Culala, MD Training Officer, Dermatology Department, Tondo Medical Center; Faculty, Dermatology Department, Jose R Reyes Memorial Medical Center, Philippines

Kara Melissa Torres Culala, MD is a member of the following medical societies: Philippine Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

Acknowledgements

Indraneel Bhattacharyya, DDS, MSD Associate Professor, Department of Oral and Maxillofacial Diagnostic Sciences, Director of Oral & Maxillofacial Pathology Residency Program, University of Florida, College of Dentistry

Indraneel Bhattacharyya, DDS, MSD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Association for Dental Research, American Dental Association, International Association for Dental Research, and International Association of Oral Pathologists

Disclosure: Nothing to disclose.

Donald Cohen, DMD, MS Professor of Oral and Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry

Donald Cohen, DMD, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Oral Nevi Clinical Presentation

Physical Examination

References

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