Oral Mucosa Hyperpigmentation

Aka: Oral Mucosa Hyperpigmentation, Melanin Pigmentation of Oral Mucosa, Oral Hyperpigmentation, Oral Melanoplakia

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II. Causes

  1. See Medication Causes of Hyperpigmentation
  2. Adrenal Insufficiency
    1. May be associated with Candidiasis in Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome
  3. Darker pigmentation related to ethnicity
  4. Medication Causes of Hyperpigmentation
  5. Neurofibromatosis 1
  6. McCune-Albright Syndrome
  7. Peutz-Jeghers Syndrome
  8. Smoker's Melanosis (Tobacco Abuse)
    1. Diffuse, patchy Gingival Hyperpigmentation related to Nicotine staining
  9. Oral melanocytic nevi
    1. Asymptomatic, small, solitary, well defined Macules or Nodules
  10. Melanotic Macules
    1. Most common Oral Mucosal Melanocyte derivatives (esp. women)
    2. Small (<1 cm), solitary, well-defined, iniformly pigmented lesions on lower lip, Gingiva or Palate

III. Differential Diagnosis

  1. See Tooth Discoloration
  2. Oral Melanoma
    1. Rare (1% of Melanomas), but devastating outcomes if missed when early, focal
    2. Most common over the Maxillary Gingiva and the Hard Palate
    3. Key features
      1. Brown-black pigmented Plaque
      2. Light-brown Macular area regions
      3. Central nodularity

IV. Management

  1. Exclude Melanoma
  2. Eliminate or reduce dosing of causative agents
  3. Consider Tooth Discoloration causes that may be discoloring mucosa as well
  4. Refractory cases
    1. Surgical mucosal stripping of hyperpigmented tissue (e.g. laser, Cryotherapy, scalpel)

V. References

  1. Glick (2020) Am Fam Physician 102(10):613-21 [PubMed]
  2. Vinay (2025) Am Fam Physician 111(3): 277-8 [PubMed]

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