Oral Pathology:  Soft Tissue Case #13


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Patient: Young child, either sex.

Chief Complaint:
The patient's parents are concerned about a pigmented area on the lower lip. The pigmentation has been present for six weeks, is asymptomatic, but is becoming progressively darker. The parents state that the child spends a lot of time in the sun.

Medical History:
No abnormalities are identified.

Dental History:
No abnormalities are identified.

Clinical Findings:
A localized area of pigmentation about 3 mm in diameter is present on the midline of the lower lip. The lesion is nonthickened, nontender and does not blanch.

Clinical Images
pigmented area on lower lip close-up of pigmented area
Lips, with Pigmented Area on Lower Lip Close-up of Lower Lip and Pigmented Area


There are no radiographs available for this case.

There are no lab reports available for this case.

There are no charts available for this case.

Localized pigmented surface lesion

Lesions to Exclude from the Differential Diagnosis:
Intravascular lesions
  ~Blanch upon pressure
Extravasated blood lesions
  ~Red, blue or purple (not brown)
  ~Resolve or begin to resolve in less than 6 weeks
  ~Do not become progressively darker
  ~The patient would have reported trauma if it had occurred on the lip
  ~Color – these are gray to black, not brown
Oral Melanotic Macule
  ~Occurs on non-exposed mucosal surfaces
  ~Does not darken when exposed to sunlight.
Nevus and melanoma
  ~Usually thickened
  ~Do not darken when exposed to sun

Lesions to Include in the Differential Diagnosis:
Ephelis (Freckle)
  ~Non-thickened, non-tender, does not blanch
  ~Color – Brown
  ~Darkens when exposed to sunlight

Patient education: It is a freckle, it will get darker with sun exposure, and no treatment is needed.  Routine follow-up is recommended.  Discuss with the patient the value of using sunscreen to prevent sun damage and skin cancer formation.

Final Diagnosis:
Ephelis (Freckle)