Oral pigmented lesions: a retrospective analysis from Brazil

Abstract

Background Pigmented lesions are uncommon in the oral mucosa, and studies investigating the incidence and types of these lesions are desired to improve the diagnostic knowledge of clinicians. The aim of this study was to analyze the distribution of oral pigmented lesions in a Brazilian population. Material and Methods A retrospective descriptive cross-sectional study was performed. Oral pigmented lesions were retrieved from the files of two oral and maxillofacial pathology services from Brazil over a 45-year period (1974-2019). The clinical data and the diagnoses of each case were retrieved and included in a Microsoft Excel® database. Results From 77.074 lesions diagnosed in this period, 761 (0.99%) represented pigmented lesions of the oral mucosa, including 351 (46.1%) melanocytic and 410 (53.9%) non-melanocytic lesions, with a higher incidence in females (73.2%) between the fourth and seventh decades of life. Amalgam tattoo (53.6%) represented the most common lesion, followed by melanotic macule (18.3%) and racial pigmentation (10.8%). Other pigmented lesions included nevus (9.9%), post-inflammatory pigmentation (3%), melanoma (2.1%), melanoacanthoma (1.4%), smoker's melanosis (0.4%), drug-induced pigmentation (0.3%), and melanotic neuroectodermal tumor of infancy (0.1%). The buccal mucosa was the most commonly affected site (25.2%), followed by the alveolar ridge (14.5%), and gingiva (11.8%). Conclusions The current findings were similar to previous studies with minor differences due methodology and characteristics of the services from where lesions were retrieved. The knowledge of these data may contribute to a better understanding of oral pigmented lesions and assist clinicians to better recognize and manage them. Key words: Pigmented lesions, pigmentation, melanin, amalgam, oral cavity.

Differential diagnoses of solitary and multiple pigmented lesions of the oral mucosa: Evaluation of 905 specimens submitted to histopathological examination

“…Data of frequency, clinical and demographic aspects found in the current study for each individual lesion are in accordance with literature. 4,7,8,24 Women were more affected, in accordance with similar reports, 8,24 but contrarily to a clinical study. 7 Accordingly, racial pigmentation and smoker's melanosis were frequent in a previous clinical study of oral pigmentations, 7 but were uncommon herein.…”

“…A low frequency of oral pigmentations was found in the current study (0.51%), and the frequency of pigmented lesions of the oral mucosa varies greatly among studies (0.86%-30.2%). 4,7,8,24 These disparities can be explained by the differences in sample size, study design, and the lesions evaluated. Of note, higher indexes were reported by clinical studies.…”

“…Amalgam tattoo and oral melanoma are more common in adults from fourth to seventh decades of life, whereas melanotic macule, acquired melanocytic nevi, and melanoacanthoma usually affect younger adults. 6,8,12,[24][25][26][27] The presence of amalgam restoration nearby the pigmentation as well as radiopaque granules are highly supportive of an amalgam tattoo. 2,14,17 Accordingly, the low percentage of radiographic image reported for amalgam tattoos in the current study help explaining why these lesions needed to be biopsied to confirm diagnosis.…”

“…Despite not mandatory, solitary lesions located in the lip vermilion are suggestive of melanotic macule, as this lesion presents a high predilection for this site. 8,19,20,24 Likely, small but raised lesions usually represent oral melanocytic nevi, and blue-colored palatal lesions are suggestive of blue nevus. 6,28 Finally, the unique feature of partial or total remission after an incisional biopsy guides the diagnosis through oral melanoacanthoma.…”

Primary melanoma of the oral cavity: A multi-institutional retrospective analysis in Brazil

“…This is mainly attributed to late diagnosis ( 13 ). Thus, it is essential to perform a histopathological evaluation of any suspicious pigmented lesion since early diagnosis, and surgical removal are essential for a favorable prognosis contributing thus to the effective treatment of these lesions and cancer prevention ( 27 ).…”