Pigmented Lesions of the Oral Mucosa

Healthy oral soft tissue presents a typical pink to red hue that reflects the degree of keratinization, quantity and activity of melanocytes, vascularization, and type of submucosal tissue of distinct topographic areas. Oral pigmentations can range from a solitary macule to large patches and broad, diffuse tumefactions. Oral mucosal melanomas may exhibit radial or vertical growth patterns. Exogenous pigmentations are usually associated with traumatic or iatrogenic events resulting in the deposition of foreign material directly into the mucosal tissues. Melanin pigmentation may be physiologic or pathologic, and may clinically present with focal, multifocal, or diffuse patterns. Melanotic macules are characterized by the presence of abundant melanin pigment in the basal cell layer without an associated increase in the number of melanocytes. Oral mucosal melanomas may exhibit radial or vertical growth patterns. The depigmentation is more apparent in patients who have a darker skin tone, yet the disease actually occurs in all races.