Oral Nevi: Background, Pathophysiology, Epidemiology

Sections

Oral Nevi

Sections Oral Nevi
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Follow-up
Media Gallery
References

Overview

Background

In 1943, Field and Ackermann described the features characteristic of intraoral nevi.^[1]Oral melanocytic nevi are benign proliferations of nevus cells in the epithelial layer, the submucosal layer, or both. As such, they are classified as junctional, intramucosal, and compound nevi. Nevi may also be classified as congenital or acquired. Unlike their cutaneous counterparts, oral melanocytic nevi are rare.

Intramucosal nevi are typically light brown and dome-shaped. These are the most common type, accounting for 64% of all reported oral nevi.^[2]Note the image 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.

View Media Gallery

The common blue nevus is the second most common type found in the oral cavity, accounting for 16.5-36% of all oral nevi.^[3]Note the image below.

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.

View Media Gallery

Junctional and compound nevi are uncommon, accounting for only 3-6% and 5.9-16.5%, respectively.^{[2, 4, 5]}

Rarer types include Spitz nevi, cellular blue nevi, congenital nevi, combined nevi, balloon cell nevi, epithelioid blue nevi, plaque-type blue nevi, halo nevi, and neurotized nevi.^{[6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26]}Dysplastic nevi have not been reported in the oral mucosa.

Pathophysiology

Nevus cells are derived from the neural crest. These cells migrate to the skin and oral mucous membranes during embryogenesis. Nevus cell formation probably begins with the proliferation of melanocytes along the basal cell layer and is possibly associated with elongation of the rete ridges. Nevus cells either lack contact inhibition or lose it shortly after the proliferation process begins. They retain melanin pigment and form nests or thèques.

Nevus cells have the ability to migrate from the basal cell layer into the underlying submucosa. Eventually, they may separate from the epidermis. Junctional nests may be lost later, and nevus cells may be confined to the submucosa. As the nevus cells penetrate into the submucosa, their pigmentation diminishes.

Genetic analysis has revealed V600E point BRAF mutation in both oral benign and malignant melanocytic lesions.^[27]

Frequency

United States

The incidence is 0.1-1.15% in the United States.^{[28, 29]}Lesions may be underreported because they often go undetected.

Mortality/Morbidity

No case of melanoma arising in or around an oral melanocytic nevus has been described.

Race

Oral nevi may occur in persons of all races. They are reported more frequently in white patients (55%) than in black patients (23%).^[28]The apparent predominance of oral nevi in whites over Asians (14%) and Hispanics (7%) may be due to the over-representation of this group among patients who underwent biopsies.

Sex

Oral mucosal nevi have a slight female predominance (1.5:1 female-to-male ratio), except for the blue nevi type, which occurs equally in both sexes.^[4]

Age

The average age at diagnosis is 35 years (range, 3-85 y).^[4]Male patients tend to be a few years older than female patients. Patients with junctional and compound nevi are relatively younger, with an average age at diagnosis of 22 and 24 years, respectively.

Clinical Presentation

Field HJ, Ackerman AA. Non-pigmented nevus on labial mucosa. Am J Orthodontics Oral Surg. 1943. 29:180-1.
Buchner A, Merrell PW, Carpenter WM. Relative frequency of solitary melanocytic lesions of the oral mucosa. J Oral Pathol Med. 2004 Oct. 33(9):550-7. [Medline].
Marques YM, de Lima Mde D, Raitz R, Pinto Ddos S Jr, de Sousa SO. Blue nevus: report of a case. Gen Dent. 2009 Jan-Feb. 57(1):e1-3. [Medline].
Buchner A, Leider AS, Merrell PW, Carpenter WM. Melanocytic nevi of the oral mucosa: a clinicopathologic study of 130 cases from northern California. J Oral Pathol Med. 1990 May. 19(5):197-201. [Medline].
Cardoso LB, Consalaro A, da Silva Santos PS, da Silva Sampieri MB, Tinoco-Araújo JE. Oral compound nevus. Dermatol Online J. 2014 Feb 18. 20(2):[Medline].
Teh M, Sinniah R. Spindle and epithelioid cell nevus of tongue at an unusual site. Oral Surg Oral Med Oral Pathol. 1989 Jan. 67(1):68-72. [Medline].
Nikai H, Miyauchi M, Ogawa I, Takata T, Hayashi Y, Okazaki H. Spitz nevus of the palate. Report of a case. Oral Surg Oral Med Oral Pathol. 1990 May. 69(5):603-8. [Medline].
Seehra J, Sen P, Lloyd R, Sloan P. Intraoral Spitz naevus: a case report. Int J Oral Maxillofac Surg. 2007 Jul. 36(7):661-2. [Medline].
Xavier RL, Vasconcelos MG, Galvão HC, Freitas Rde A, Souza EL, Pinto LP. Intra-oral Spitz naevus: a case report. Clinics (Sao Paulo). 2008 Feb. 63(1):140-2. [Medline]. [Full Text].
Piperi EP, Tosios KI, Sklavounou A, Stich E, Koutlas IG. Junctional spitz tumor (nevus) of the upper lip. Head Neck Pathol. 2014 Sep. 8(3):354-8. [Medline]. [Full Text].
Li CC, Harrist TJ, Noonan VL, Woo SB. Intraoral Spitz nevus: case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014 Apr. 117(4):e320-4. [Medline].
Takeda Y. Congenital nevocellular nevus of the oral mucosa. Ann Dent. 1988 Winter. 47(2):40-2. [Medline].
Reychler H. [Oral nevocellular nevus]. Rev Stomatol Chir Maxillofac. 1988. 89(2):97-101. [Medline].
Ojha J, Akers JL, Akers JO, Hassanein AM, Islam NM, Cohen DM, et al. Intraoral cellular blue nevus: report of a unique histopathologic entity and review of the literature. Cutis. 2007 Sep. 80(3):189-92. [Medline].
Allen CM, Pellegrini A. Probable congenital melanocytic nevus of the oral mucosa: case report. Pediatr Dermatol. 1995 Jun. 12(2):145-8. [Medline].
Gilbert ML, Hanna W, Ghazarian D, Dover D, Klieb HB. Congenital melanocytic nevus of the oral mucosa: report of a rare pigmented lesion and review of the literature. Clin Pract. 2011 Mar 29. 1(1):e17. [Medline]. [Full Text].
Ficarra G, Hansen LS, Engebretsen S, Levin LS. Combined nevi of the oral mucosa. Oral Surg Oral Med Oral Pathol. 1987 Feb. 63(2):196-201. [Medline].
Barker GR, Sloan P. An intraoral combined blue naevus. Br J Oral Maxillofac Surg. 1988 Apr. 26(2):165-8. [Medline].
Damm DD, White DK, Lyu PE, Puno P. Balloon cell nevus of the oral mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Jun. 105(6):755-7. [Medline].
Ide F, Obara K, Enatsu K, Mishima K, Saito I. Balloon cell nevus of the soft palate: an immunohistochemical and ultrastructural study. Pathol Int. 2004 Nov. 54(11):872-6. [Medline].
Gulati A, Singhal D, Lal D, Agarwal AK. Balloon cell nevus of the pharynx. Head Neck. 2004 Oct. 26(10):910-4. [Medline].
Pinto A, Raghavendra S, Lee R, Derossi S, Alawi F. Epithelioid blue nevus of the oral mucosa: a rare histologic variant. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Oct. 96(4):429-36. [Medline].
Hanna A, Rawal SY, Anderson KM, Rawal YB. The epithelioid blue nevus: A rare intraoral nevomelanocytic tumor. J Oral Maxillofac Pathol. 2011 Jan. 15(1):88-90. [Medline]. [Full Text].
Fistarol SK, Itin PH. Plaque-type blue nevus of the oral cavity. Dermatology. 2005. 211(3):224-33. [Medline].
Ajagbe O. Halo nevus: an unusual upper lip presentation in a black patient and a review of the subject. NDA J. 1994 Jan-Feb. 45(1):19-23. [Medline].
Ide F, Mishima K, Yamada H, Saito I, Tanaka A, Kusama K. Neurotized nevi of the oral mucosa: an immunohistochemical and ultrastructural analysis of nevic corpuscles. J Oral Pathol Med. 2007 Sep. 36(8):505-10. [Medline].
Cohen Y, Goldenberg-Cohen N, Akrish S, Shani T, Amariglio N, Dratviman-Storobinsky O, et al. BRAF and GNAQ mutations in melanocytic tumors of the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Dec. 114(6):778-84. [Medline].
King OH Jr, Blankenship JP, King WA, Coleman SA. The frequency of pigmented nevi in the oral cavity. Report of five cases. Oral Surg Oral Med Oral Pathol. 1967 Jan. 23(1):82-90. [Medline].
Buchner A, Hansen LS. Pigmented nevi of the oral mucosa: a clinicopathologic study of 36 new cases and review of 155 cases from the literature. Part I: A clinicopathologic study of 36 new cases. Oral Surg Oral Med Oral Pathol. 1987 May. 63(5):566-72. [Medline].
Buchner A, Hansen LS. Pigmented nevi of the oral mucosa: a clinicopathologic study of 36 new cases and review of 155 cases from the literature. Part II: Analysis of 191 cases. Oral Surg Oral Med Oral Pathol. 1987 Jun. 63(6):676-82. [Medline].
Hicks MJ, Flaitz CM. Oral mucosal melanoma: epidemiology and pathobiology. Oral Oncol. 2000 Mar. 36(2):152-69. [Medline].
Harada H, Morimatsu M, Kusukawa J, Kameyama T. A hamartoma-like mass on the palate? A possible discussion regarding the components of a pigmented naevus and hyperplastic salivary gland. J Laryngol Otol. 1997 Mar. 111(3):296-9. [Medline].
Wijs RW, Meleti M, Bloemena E, van der Waal I. [A non-pigmented naevus as an uncommon gingival swelling]. Ned Tijdschr Tandheelkd. 2012 Jun. 119(6):283-4. [Medline].
Biesbrock AR, Aguirre A. Multiple focal pigmented lesions in the maxillary tuberosity and hard palate: a unique display of intraoral junctional nevi. J Periodontol. 1992 Aug. 63(8):718-21. [Medline].
Lai WS, Hsu CH, Lee JC, Chu YH. Extensive blue nevus of the pharynx. Indian J Dermatol Venereol Leprol. 2012 May-Jun. 78(3):376-7. [Medline].
Kauzman A, Rei N, Avon SL. The blue nevus: a rare lesion of the oral cavity. Gen Dent. 2014 Sep-Oct. 62(5):e22-6. [Medline].
Kauzman A, Pavone M, Blanas N, Bradley G. Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations. J Can Dent Assoc. 2004 Nov. 70(10):682-3. [Medline].
Müller S. Melanin-associated pigmented lesions of the oral mucosa: presentation, differential diagnosis, and treatment. Dermatol Ther. 2010 May-Jun. 23(3):220-9. [Medline].
Hansen LS, Buchner A. Changing concepts of the junctional nevus and melanoma: review of the literature and report of case. J Oral Surg. 1981 Dec. 39(12):961-5. [Medline].
Suzuki T, Kumamoto H, Nagasaka H, Kawamura H, Ooya K. Intramucosal naevus with pseudoepitheliomatous hyperplasia in the gingiva: a case report. Int J Oral Maxillofac Surg. 2002 Jun. 31(3):330-3. [Medline].
Fujita S, Takahashi H, Tsuda N, Okabe H. Immunohistochemical localization of S-100 protein and its subunits in melanotic lesions in the oral mucosa and skin. J Oral Pathol Med. 1991 Oct. 20(9):429-32. [Medline].
Gazit D, Daniels TE. Oral melanocytic lesions: differences in expression of HMB-45 and S-100 antigens in round and spindle cells of malignant and benign lesions. J Oral Pathol Med. 1994 Feb. 23(2):60-4. [Medline].
de Andrade BA, León JE, Carlos R, Delgado-Azañero W, Mosqueda-Taylor A, de Almeida OP. Expression of minichromosome maintenance 2, Ki-67, and geminin in oral nevi and melanoma. Ann Diagn Pathol. 2013 Feb. 17(1):32-6. [Medline].
Benevenuto-de-Andrade BA, León JE, Carlos R, Delgado-Azañero W, Mosqueda-Taylor A, Paes-de-Almeida O. Immunohistochemical expression of Skp2 protein in oral nevi and melanoma. Med Oral Patol Oral Cir Bucal. 2013 May 1. 18(3):e388-91. [Medline]. [Full Text].
Porrini R, Valente G, Colombo E, Cannas M, Sabbatini M. Non pigmented melanocytic nevus of the oral cavity: a case report with emphasis on the surgical excision procedures. Minerva Stomatol. 2013 Jan-Feb. 62(1-2):43-9. [Medline].
Meleti M, Mooi WJ, Casparie MK, van der Waal I. Melanocytic nevi of the oral mucosa - no evidence of increased risk for oral malignant melanoma: an analysis of 119 cases. Oral Oncol. 2007 Nov. 43(10):976-81. [Medline].
Dyer PV, Eveson JW. Recurrent compound naevus of gingiva. J Periodontol. 1993 Aug. 64(8):739-41. [Medline].
Torres Fernández G. Pigmented lesion of the oral cavity with eight years follow-up. P R Health Sci J. 2000 Jun. 19(2):165-8. [Medline].

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.

of 3

Author

Kara Melissa T Torres, MD, DPDS Visiting Research Fellow, Ackerman Academy of Dermatopathology

Kara Melissa T Torres, MD, DPDS 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 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: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

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

Background

Pathophysiology

Epidemiology

Frequency

Mortality/Morbidity

Race

Sex

Age

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Oral Nevi

Background

Pathophysiology

Epidemiology

Frequency

Mortality/Morbidity

Race

Sex

Age

References

Tables

Contributor Information and Disclosures

What would you like to print?

Find Us On

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Related Conditions and Diseases

Medscape Consult

News & Perspective

Tools

Slideshow

Most Popular Articles

Recommended