Oral Nevi Differential Diagnoses

Updated: Sep 12, 2022
  • Author: Kara Melissa Torres Culala, MD; Chief Editor: Dirk M Elston, MD  more...
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Diagnostic Considerations

Oral junctional nevi, atypical melanocytic hyperplasia, and malignant melanoma may have similar clinical presentations, and lesions initially diagnosed as oral junctional nevi may subsequently be shown to be atypical melanocytic hyperplasia. [52] A few cases of oral melanoma in situ misdiagnosed as junctional nevi have also been reported. [33] It is imperative that the definitive diagnosis be confirmed through biopsy.

Differentials for focal pigmented lesions are as follows:

  • Melanotic macule

  • Melanoacanthoma

  • Mucosal melanoma

  • Amalgam tattoo

  • Hemangioma

  • Kaposi sarcoma

  • Racial pigmentation

  • Varix

  • Vascular malformation

  • Thrombus Hematoma

Differentials for diffuse pigmented lesions are as follows:

  • Smoker’s melanosis

  • Physiological pigmentation

Drug-induced lesions may be caused by the following:

  • Antimalarials: Quinacrine, chloroquine, hydroxychloroquine

  • Antibiotics: Minocycline, tetracycline

  • Antifungals: Ketoconazole

  • Antimycobacterials: Clofazimine

  • Antiretrovirals: Zidovudine

  • Antineoplastics: Bleomycin, busulfan, tacrolimus, cyclophosphamide, doxorubicin, hydroxyurea

  • Cardiac drugs: Amiodarone, quinidine

  • Psychiatric drugs: Chlorpromazine

  • Estrogen: Oral contraceptives

  • Gold therapy

Post-inflammatory hyperpigmentation/hypopigmentation should be considered in the differential diagnosis.

Systemic conditions to consider in the differential diagnosis are as follows:

  • Peutz-Jeghers syndrome

  • Laugier-Hunziker syndrome

  • Addison disease

  • McCune-Albright syndrome

  • Neurofibromatosis

Non-pigmented/amelanotic lesions to consider are as follows:

  • Fibroma

  • Fibrous hyperplasia

  • Papilloma