Oral melanotic macule and primary oral malignant melanoma: epidemiology, location involved, and clinical implications.

Department of Dermatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology (Impact Factor: 1.5). 07/2011; 112(1):e21-5. DOI: 10.1016/j.tripleo.2011.02.040
Source: PubMed

ABSTRACT Oral malignant melanoma must be differentiated from melanotic macule.
Retrospective review of 2 series of oral melanotic macule (n = 52) and oral melanoma (n = 130) were conducted to investigate the epidemiology and location involved and assess their differences.
The mean age of oral melanotic macule patients was 47.3 years, with female:male ratio 2.1 and the lower lip being the predominant location. The mean age of oral melanoma patients was 53.8 years, with no observed sex predilection and the main locations being palate and gingiva. Differences between the 2 cohorts in age (P = .006), gender (P = .014), and lesion site (P < .001) were noted. In this review, 1 case of oral melanotic macule was found to subsequently develop into melanoma.
Oral melanotic macule may possess malignant potential. Biopsy is recommended to differentiate oral melanoma from melanotic macule for male patients >60 years old with suspected melanotic macule lesion located on the palate.

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    ABSTRACT: Pigmentations of the oral mucosa include a range of lesions or conditions that manifest as changes in the color of oral tissues; these changes may show melanocytic activity. A melanotic macule is a small, well-circum-scribed melanocytic benign lesion. It can occur on the lips and intraorally and ranges in color from brown to black. Microscopically, it is character-ized by elevated levels of melanin production by basal melanocytes, which appear normal in terms of number, morphology, and distribution. A 48-year-old woman sought treatment for a pigmented lesion that had been present for 4 months. Intraoral examination revealed a non-homogenous brownish spot (measuring 0.7 cm) with irregular borders on the left side of the soft palate. Since the lesion had an atypical clinical ap-pearance, melanocytic nevus, oral melanoacanthoma, and oral malignant melanoma were considered in differential diagnoses. After an incisional biopsy, the lesion was diagnosed as a melanotic macule. Due to their varying clinical appearance, benign pigmented lesions can be mistaken for malignant tumors, especially when the lesions exhibit similar coloration, symmetry, and borders. Through this report on a case with atypical clinical characteristics, we aim to reinforce the ubiquitous nature of oral pigmented lesions, and the importance of employing different approaches to diagnosing these lesions.
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