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Case Studies — Pigmented Lesions
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Pigmented Lesions: Case Study #1
Patient: 70-Year-Old Male
Diagnosis: Amalgam Tattoo
Location: Tongue / Floor of Mouth
Morphology: Pigmented Lesion
History of Present Illness
A 70-year-old man presents with an unknown history of asymptomatic dark lesion on the right ventral tongue, discovered during a dental/hygiene examination. Currently, the patient denies any oral functional limitation or para-functional habits.
Medical History
The patient has recently been diagnosed with diabetes, and is currently on Glyburide and Avapro. He does not smoke nor drink, and reports no history of allergies.
Examination
Peri-oral examination was unremarkable with no lymphadenopathy identified in the head and neck region. Range of motion of TMJ was within normal limit. Intra-oral examination revealed a moist oral environment. A discrete triangular homogenous pigmented macule measuring 5mm x 8mm was found on the right ventral tongue/floor of mouth. No adjacent erythema identified. History of coronal restoration was evident juxtaposing the lesion. Autofluorescence examination showed no significant findings. The rest of the oral mucosal tissue was unremarkable, and dentition was grossly intact.
Clinical Implications & Recommendations
The clinical finding was compatible with amalgam tattoo or melanotic macule, a benign process in response to previous trauma. However, ongoing monitoring is advised, and size and color changes should warn a tissue biopsy.
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Case Study #2: Presentation under White Light and Fluorescence
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Pigmented Lesions: Case Study #2
Patient: 56-Year-Old Female
Diagnosis: Amalgam Tattoo
Location: Right Buccal Mucosa
Morphology: Pigmented Lesion
History of Present Illness
A 56-year-old woman presents with chronic lesions on the right posterior buccal mucosa. She is unable to recall any traumatic event on the area. Although asymptomatic, she is worried about the potential pathology. She has a history of amalgam restoration at the upper right dentition, followed by a crown and bridge replacement.
The patient is currently taking Lipitor and Synthyroid. She does not drink nor smoke. She reports an allergy to sulfur drugs, to which she reacts with skin eruptions. The patient’s family has a history of cancer. Her mother has a recent diagnosis of squamous cell carcinoma and melanoma on the right arm. Her sister has a history of breast cancer. Her father has a history of lung cancer.
Examination
The patient was relaxed. No palpable lymphadenopathy was identified at the head and neck regions. Peri-oral examination was unremarkable. Intra-oral examination revealed a moist oral cavity. A diffused bluish/dark pigmented lesion, measuring approximately 1cm, was found at the right posterior buccal mucosa. Another similar lesion, measuring <4mm at its greatest dimension, was found at the right anterior buccal mucosa. The lesion juxtaposed the occlusal plane. The rest of the oral mucosa, including the palate, floor of the mouth, and bilateral ventral tongue, were within normal limits.
Clinical Impressions / Management Suggestions
Patient's clinical presentation is highly suggestive of amalgam tattoo. However, due to her family history of cancer, tissue biopsy was performed to rule out any potential malignancy.
Follow-Up
The biopsy result confirmed amalgam tattoo. Re-examination of the biopsy site showed well-healed mucosal tissue. Due to the benign nature of the ongoing lesion, no further active management is recommended at this time.
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Slides (Click on Thumbnails):
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