Pigmented Lesions
of the Oral Cavity
Case Presentation
A 58-year-old female presented to her general dentist for routine oral examination
and prophylaxis. Her medical and social histories were non-contributory. Intraoral
exam revealed an asymptomatic, pigmented macule of the attached gingiva in the
area of the mandibular right canine and first premolar (#27 and #28) (Figure 1).
As per the patient, the lesion appeared recently. Due to the small size of the lesion,
an excisional biopsy was performed, and the specimen was submitted for
histopathologic evaluation. Histopathologic examination revealed scattered black,
variably sized, granular particles and fragments of material in the connective tissue,
and golden-brown staining of the collagen fibers (Figure 2). The particles were
associated with minimal inflammation and fibrosis. Finally, focal golden-brown
staining of the basement membrane of the overlying epithelium was observed.
Figure 1.
Authors
Tessie B. Stansbury, DMD*
Chief Resident, Oral and Maxillofacial Pathology,
University of Pittsburgh Medical Center
Richard J. Vargo, DMD
Resident, Oral and Maxillofacial Pathology,
University of Pittsburgh Medical Center
Elizabeth A. Bilodeau DMD, MD,
MSEd
Associate Professor, Oral and Maxillofacial Pa-
thology, School of Dental Medicine, University
of Pittsburgh
*To whom correspondence should
be addressed.
Email: tmb55@pitt.edu
Address: G-132, 3501 Terrace Street,
Pittsburgh, PA 15261
Figure 2.
A clinical photograph showing a darkly
pigmented macule of the gingiva.
Granular foreign material is seen
in the connective tissue. Note the
golden brown staining of the
connective tissue reticulin fibers
(green arrow) and epithelial
basement membrane (yellow
arrows), which is characteristic
of amalgam tattoos. Basal
and parabasal melanin are
conspicuously absent (H&E 200x).
What is the most likely diagnosis?
A. Amalgam tattoo
B. Melanotic macule
C. Intraoral melanocytic nevus
D. Mucosal melanoma
JU LY/AU
LY/AU G
G U
U ST
ST 2017
2017 | | P P EN
EN N
N SYLVAN
SYLVAN IA
IA DEN
DEN TAL
TAL JOURNAL
JOURNAL
JU
31
31