Thursday, January 26, 2006

Oral Hyperpigmentation

This 21 years student noticed hyperpigmentaiton of her buccal mucosae for one weeks.
She has gingival hyperpigmentation for years and has a family history of the latter.
Her health is good, and her only medication are albuterol and cromolyn sodium for asma.
No history of cancer in any first degree relation.

The examination show hyperpigmented buccal maculas measuring up to > 1 cm in diameter.
Gingival hyperpigmentation is present as well.

In the differential diagnosis I would consider pigmented fixed drug eruption, amalgam tattoo, melanoacanthoma. Biopsy may be offered. Melanoma is unlikely.

Presented by
Mordechai Pepe Grosbartt
ConcepciĆ³n, Chile


  1. The first thing that comes to my mind is Peutz-Jeghers syndrome. As i can see in this nice photos there are also some pigmentations even on tongue and lips. Any GI symptom?
    Mucosal melanotic macule is my next Dx. Regarding the distribution of the pigmentation it couldn't be a fixed drug eruption. Keep us updated after Bx. Thanks, omid

  2. I would make sure we are not dealing with Addison's hyperpigmentation. Having excluded that, wonder if these could be some variants of mucosal lentigenes. A biopsy would be useful. Do keep us updated on this interesting case.


  3. Peutz Jegher sdr : autosomal domonant,melanin pigmentation of oral mucosaand lips,hamartomatous poalips(primarily of small intestine). Increased risk of cancer of lung ,pancreas.


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