Approach Considerations

Consider the following in the diagnostic approach:

Clinical presentation with documentation of lesion presentation, growth rate, and parallel stimuli present
Comorbidities
Medications

Procedures

The clinical features of cutaneous and mucosal lesions may mimic those of other pigmented lesions; therefore, definitive diagnosis is based on histologic examination. Incisional or excisional biopsy may be performed based on the size and anatomic location of the lesion. Insulinlike growth factor 2 mRNA-binding protein-3 has been suggested to help histologically differentiate keratoacanthoma from squamous cell carcinoma.^[23]

Histologic Findings

Microscopic examination reveals a hyperplastic edematous stratified squamous epithelium with acanthosis and elongated widened rete ridges.^[24]Increased melanin pigmentation is present in the basal layer (see image below). In addition, many proliferating dendritic melanocytes or clear cells extend upward into the prickle-cell layers (see images below).

Increased melanin pigmentation in the basal layer of a melanoacanthoma (hematoxylin and eosin, original magnification X10).

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Proliferating dendritic melanocytes in the prickle-cell layers of a melanoacanthoma (hematoxylin and eosin, original magnification X40).

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The clinical and histologic features of oral melanoacanthoma lesions can resemble those of melanoma in situ.^[25]Usually, no evidence of cellular pleomorphism or abnormal mitotic activity is seen in oral melanoacanthoma, and this feature excludes malignancy.

In mucosal lesions, mixed chronic inflammatory cells and numerous melanin-laden macrophages densely infiltrate the stratum corneum. This inflammatory process may indicate the reactive rather than the neoplastic nature of the lesion.^{[26, 27]}

Treatment & Management

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Boussemart L, Girault I, Malka-Mahieu H, Mateus C, Routier E, Rubington M, et al. Secondary Tumors Arising in Patients Undergoing BRAF Inhibitor Therapy Exhibit Increased BRAF-CRAF Heterodimerization. Cancer Res. 2016 Mar 15. 76 (6):1476-84. [QxMD MEDLINE Link].
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Media Gallery

Diagram of a pigmented epithelial macule.
Intraoral melanoacanthoma lesion on the mandibular gingiva.
Increased melanin pigmentation in the basal layer of a melanoacanthoma (hematoxylin and eosin, original magnification X10).
Proliferating dendritic melanocytes in the prickle-cell layers of a melanoacanthoma (hematoxylin and eosin, original magnification X40).

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Author

Claudia C Cotca, DDS, MPH Founder, Dental Director, Aesthetic Restorative Dentist, Washington Institute For Dentistry and Laser Surgery

Claudia C Cotca, DDS, MPH is a member of the following medical societies: Academy of Laser Dentistry, Alpha Omega International Dental Fraternity, American Academy of Dental Science, American Academy of Dental Sleep Medicine, American Academy of Implant Dentistry, American Academy of Oral Medicine, American Association for Women Dentists, American Dental Association, American Diabetes Association, American Equilibration Society, American Red Cross, American Society for Laser Medicine and Surgery, Arthritis Foundation, District of Columbia Dental Society, Facial Pain Association, FDI World Dental Federation, Global Health Council, International College of Dentists, International College of Prosthodontists, Muscular Dystrophy Association, National Association of Women Business Owners

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Washington Institute For Dentistry & Laser Surgery, C3 Think Tank<br/>Serve(d) as a speaker or a member of a speakers bureau for: Washington Institute For Dentistry & Laser Surgery, Lightscalpel, AMD, & other industry participants<br/>Have a 5% or greater equity interest in: Washington Institute For Dentistry & Laser Surgery, C3 Think Tank<br/>Received income in an amount equal to or greater than $250 from: Washington Institute For Dentistry & Laser Surgery, C3 Think Tank. AMD Lasers, Lightscalpel, .

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Jeff Burgess, DDS, MSD (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research Associates

Disclosure: Nothing to disclose.

Additional Contributors

Neil Shear, MD Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Talib Najjar, DMD, MDS, PhD Professor of Oral and Maxillofacial Surgery and Pathology, Rutgers School of Dental Medicine

Talib Najjar, DMD, MDS, PhD is a member of the following medical societies: American Society for Clinical Pathology

Disclosure: Nothing to disclose.

Thomas A Chiodo, DDS Staff Dentist, Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry of New Jersey; Private Practice, Oral and Maxillofacial Surgery

Thomas A Chiodo, DDS is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association

Disclosure: Nothing to disclose.

Nathan Wuebbels, DMD, MD Staff Physician, Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry, New Jersey, University Hospital

Nathan Wuebbels, DMD, MD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association, American Student Dental Association

Disclosure: Nothing to disclose.

Oral Melanoacanthoma Workup

Approach Considerations

Procedures

Histologic Findings

References

Tables

Contributor Information and Disclosures

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