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Oral Pathology:  Soft Tissue Case #15

 

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Patient: Adult, either sex.

Chief Complaint:
Patient requests a routine examination.

Medical History:
No abnormalities identified.

Dental History:
No abnormalities identified. The patient does not wear dentures.

Clinical Findings:
Multiple, blue to black areas with irregular borders are located on the right maxillary tuberosity, hard palate, and soft palate. The pigmented lesions are nontender and smooth to palpation. They do not blanch and do not rub off. Some of the lesions are flat and nonthickened, while other areas are thickened and firm to palpation. All the pigmented areas are fixed to the surface mucosa, but only the thickened areas are fixed to the underlying structures. No radiographic abnormalities are identified. The patient was unaware of the lesions. There are no palpable lymph nodes or other palpable masses. No skin lesions are identified.

Clinical Image
pigmented areas on palate
Pigmented Areas on Palate

 

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.

Summary:
This is a localized pigmented surface lesion of the oral mucosa
  ~Blue to black color with irregular borders
  ~Varies from flat to thickened
  ~Consists of multiple pigmented areas within a localized region
  ~Does not blanch

Lesions to Exclude from the Differential Diagnosis:
Tattoo
  ~Does not present with variable thickness, color and multiple areas unless history of  major trauma, such as shrapnel or motor vehicle accident
Intravascular Lesions
  ~Blanch upon pressure
Ecchymosis and Petechiae
  ~Flat
Hematoma and Thrombosed Varix
  ~Not fixed to the underlying structures
  ~No history of trauma
Ephelis, Nevus, Oral Melanocytic Macule
  ~Do not vary in color or thickness
  ~Not that large
  ~Are symmetrical

Lesions to Include in the Differential Diagnosis:

Melanoma
  ~Asymmetry and irregular borders
  ~Variation in color
  ~Variation in thickness
  ~Diameter greater than 6 mm with multiple areas

Management:
The irregular clinical appearance of a large pigmented lesion is very suggestive of melanoma.  Explain your suspicions about the lesion to the patient, and refer to an oral surgeon or physician as soon as possible for incisional biopsy.   The fact that this lesion is thickened and fixed to underlying structures in mucosa that are normally not attached (soft palate), indicates that it is an advanced lesion.

Final Diagnosis:
Melanoma