DIAGNÓSTICO DIFERENCIAL DE LAS MANCHAS MELANOCÍTICAS EN LA CAVIDAD ORAL

Abstract

Introduction: Pigmented lesions of the oral mucosa are numerous and are caused by abnormal collection of melanin or endogenous and exogenous pigments. There are two categories of pigmented lesions: melanocytic and nonmelanocytic lesions. Melanocytic lesions include oral melanotic macules, drug-induced pigmentations (minocycline, antimalarials, some chemotherapeutic agents, oral contraceptives…), smoker's melanosis, oral melanoacanthoma, melanocytic nevi and melanoma. Nonmelanocytic pigmentation includes amalgam tattoos, a common material used for dental restorations. Differential diagnosis requires a careful medical and medication history and a complete head and neck physical examination. In some cases, biopsies can be taken and imaging studies are also helpful.Methods: We report a 53-year-old male patient with a smoking history. The patient was referred to our service by his dentist with a history of an asymptomatic lesion on the tongue. Intraoral examination showed a brown, well-circumscribed macule on the right hemi-tongue ventral surface and an indurated 20 x 5 mm lesion. The rest of the physical examination was normal. Magnetic resonance imaging (MRI) showed no significant findings. Anatomopathological study was performed and confirmed the diagnosis of oral melanotic macule.Conclusion: Melanocytic lesions of the oral mucosa are numerous and range from benign conditions to malignant ones such as melanoma. Differential diagnosis is particularly important and requires a careful medical history, complete head and neck physical examination and anatomopathological study.  Keywords: oral melanotic macules, smoker's melanosis, oral melanoacanthoma, melanocytic nevi, melanoma.