Sunday, March 27, 2016

Labial Macules

The patient is a 33 year-old woman who recently noted pigmented macules on her lower lips.  She admits to having an anxiety disorder and being preoccupied with her health (which is otherwise excellent).  Her anxiety dates back to the death of her father from colon cancer at age 52 (when she was 10 years old).  She was seen for an unusual cheilitis in 2010 and her case was presented on VGRD then.

O/E:  There are six lightly pigmented macules on her lower lip.  No other pigmentation on her oral mucosae. No other pigmented macules noted.

Discussion: While these macules could be post-inflammatory changes from her allergic cheilitis, it's hard to ignore her family history and the possibility that they could be a forme fruste of Peutz-Jeghers Syndrome.  Endoscopy seems, to me at least, to be indicated.  With classical PJS the pigmented macules may be present even in infancy or childhood.  Visualizing her G.I. tract is important here, if only to allay this woman's anxiety.

Your thoughts will be appreciated.

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3 comments:

  1. UnknownMarch 27, 2016

    I would try all the non invasive tests before
    endoscopy. Occult blood in stools and Gene testing Mutations in the STK11 gene (also known as LKB1) is present in the majority of cases.

    ReplyDelete
  2. Humane Medicine HuiMarch 28, 2016

    From Khalifa Sharquie, Baghdad: I wonder whether this patient is smoker or not as chronic smoker individuals commonly have oral pigmented macules similar to lip macules in this patient .Smoker pigmented macules commonly involve cheek mucosae but any part could be affected .Smoking should be asked about in this patient and the whole oral mucosa should checked up

    ReplyDelete
  3. ASHOK KUMAR SHARMAMarch 28, 2016

    Laugier Hunziker Syndrome should also be considered.

    ReplyDelete

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