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Oral Pathology:  Soft Tissue Case #16

 

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Patient: Young child, either sex.

Chief Complaint:
Patient's parents request a routine examination.

Medical History:
No abnormalities are identified.

Dental History:
Routine regular care.

Clinical Findings:
A solitary, well-circumscribed, pigmented lesion is present at the junction of the hard and soft palate. The lesion is thickened, firm to palpation, nontender and does not blanch upon pressure. It is fixed to surface mucosa. That portion of the lesion on the hard palate is fixed to underlying structures. The patient and parents were unaware of the lesion.

Clinical Images
teeth, hard and soft palate on right side close-up of hard palate
Teeth, Hard and Soft Palate on Right Side Close-up of Hard 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

Lesions to Exclude from the Differential Diagnosis:
Intravascular blood lesions
  ~Blanch upon pressure
  ~Color – red, blue or purple
Extravasated blood lesions
  ~Red, Blue or Purple, not brown
Ephelis
  ~Flat and not thickened
  ~Occurs only on sun-exposed skin
Oral Melanotic Macule
  ~Flat and not thickened

Lesions to Include in the Differential Diagnosis:
Nevus
  ~Raised and smooth
  ~Brown to tan in color
Melanoma
  ~Since the patient is so young, this lesion is unlikely
Tattoo
  ~Cannot be excluded because it could be due to amalgam or graphite from a lead pencilHematoma
  ~Cannot be excluded even though there is no history of trauma because trauma in the mouth during eating can occur without a history, especially for children.

Management:
Excisional biopsy is indicated for any lesion in which nevus or melanoma are included in the differential diagnosis.  Explain the differential diagnosis to the patient and parents and the indications for biopsy.  Melanoma in a child is rare but must still be considered.

Final Diagnosis:
Tattoo from graphite due to traumatic implantation of pencil lead