Oral pigmented lesions: a retrospective analysis from Brazil

Prevalence and associated factors of oral pigmented lesions among Yemeni dental patients: a large cross-sectional study

BACKGROUND

The literature is scarce and inconsistent regarding the prevalence, types, and risk factors of oral pigmented lesions (OPL). The present study investigated the prevalence, types, and distribution of OPL, as well as their associated factors among Yemeni dental patients.

METHODS

This cross-sectional study was conducted among 1920 dental patients attending the dental clinics, Sanaa University, Yemen over a period of 10 months (from March to December 2021). A comprehensive clinical examination was conducted by a well-trained and calibrated examiner, and histopathological analysis was carried out in suspicious cases.

RESULTS

Out of the 1920 subjects, 1091 (56.8%) were diagnosed with one or more OPL. The most common OPL were physiologic pigmentations (33.8%), smoker's melanosis (14.6%), melanotic macule (2.6%), and vascular-related pigmentations (varix, hemangioma, hematoma). Gingiva and buccal mucosa were the most involved sites. Male subjects showed higher prevalence of smoker's melanosis, black hairy tongue, vascular-related pigmentations, whereas physiologic pigmentation, melanotic macule and melanotic nevi were more common in females. The results revealed that being male (p < 0.001), over 40 years old (p = 0.001), smoker (p < 0.001), waterpipe smoker (p = 0.004), and being dark-skinned (p < 0.001) are determinant factors for the occurrence of OPLs.

CONCLUSION

The prevalence of OPL among Yemeni population is high, with the gingiva and buccal mucosae are the most common sites of oral pigmentations. Male gender, smoking habits, and dark skin complexion are risk factors for developing OPLs. Understanding the etiology and clinical features of common OPL is paramount for accurate diagnosis and management of these lesions.

Evaluation of Gingival Pigmentation and Related Factors on Former Smokers

Objectives

Gingival pigmentation, the most common etiological factor of which is smoking, is a clinical condition that causes aesthetic complaints. Due to the dose-dependent effect of smoking, gingival pigmentation may present regression following cessation. This cross-sectional study aimed to evaluate gingival pigmentation in former tobacco consumers and compare with current ones.

Material and Methods

A total of 110 people, 70 of whom were current smokers (Group CS) and 40 of whom were former smokers (Group FS), were included in the study. Participants filled out the data collection forms containing questions on demographic features and information related to tobacco consumption. In addition, all individuals were examined with Hedin's melanin index (HMI) to evaluate gingival pigmentation. Statistical significance was set at the P < 0.05 level.

Results

The population consisted of 57.3% male, and the mean age of all participants was 39.43 (SD 12.3) years. The mean duration of tobacco consumption did not differ between groups, whereas the mean HMI score of Group FS was significantly lower (P = 0.001). The correlation analyses showed that while the HMI score of Group CS was in relation to both daily consumption amount and duration of consumption (for both, P < 0.01), the HMI score of Group FS showed a negative association with only time elapsed after cessation (P = 0.000).

Conclusions

Considering the limitations of this study, the outcomes revealed a dose- and a time-dependent relation of gingival pigmentation in smokers. However, gingival pigmentation in former tobacco consumers was negatively correlated only with time elapsed after cessation.

Oral melanoacanthoma: Clinicopathological and immunohistochemical features of a case series and a scoping review

BACKGROUND

This study presents a case series and scoping review of oral melanoacanthoma to examine its clinical, histopathological, and immunohistochemical characteristics.

METHODS

Nine cases of oral melanoacanthoma were included in the case series. Clinical data were collected from biopsy charts. Hematoxylin-eosin and immunohistochemistry for TRP2, CD3, and CD20 were done. For the scoping review, MEDLINE/PubMed, Web of Science, EMBASE, and Scopus were searched.

RESULTS

Case series: The mean age was 46.8 years (female-to-male ratio 2:1). Lesion's mean size was 11.0 mm (±9.3). Lesions were mainly macular (77.8%) with brown or black coloration (88.9%) and often affected multiple sites (44.4%). The evolution time ranged from 15 days to 96 months. Lesions commonly showed epithelial acanthosis (66.7%), spongiosis (55.6%), exocytosis (77.8%), melanin incontinence (88.9%), and inflammatory infiltrate in the lamina propria (77.8%), from which all showed lymphocytes. TRP2-positive melanocytes were identified in the basal and spinous layer of all cases, and in the superficial layer of three cases. CD3-positive cells predominate over the CD20-positive. Scoping review: 85 cases of oral melanoacanthoma were retrieved from 55 studies. Patients were primarily female (female-to-male ratio 2.2:1), black-skinned (64.1%), with a mean age of 36.13 (± 17.24). Lesions were flat (81.9%), often brown (62.4%). Buccal mucosa was the preferred site (32.9%), followed by multiple sites (28.2%).

CONCLUSION

Oral melanoacanthoma mainly affects women across a wide age range, with lesions commonly appearing as brown/black macules, particularly on the buccal mucosa. TRP2-positive melanocytes and T-lymphocytes were consistently found and could participate in oral melanoacanthoma pathogenesis.

Efficacy and Risks of Different Treatments for Oral Hyperpigmentation: A Systematic Review and Network Meta-Analysis

BACKGROUND

Oral-pigmented lesions have raised aesthetic concerns, leading to multiple depigmentation techniques. This systematic review and network meta-analysis aimed to assess the efficacy of different treatments for oral hyperpigmentation.

METHODS

A computerized search was conducted on Science Direct, Medline via PubMed, Scopus, and Web of Science using the relevant keywords. English-language studies published between 2013 and 2023 that focused on patients with oral pigmented lesions subjected to different treatment modalities, such as laser or surgical intervention, were compared to determine their efficacy and safety profile. Data were analyzed using R software, applying frequentist models.

RESULTS

A total of 27 studies were included. In contrast to the CO2 laser, Er: YAG laser was linked to a higher risk of bleeding (RR = 2.73, p < 0.01), whereas the diode laser had the most favorable score in minimizing bleeding index (P-score = 0.86). In terms of lower risk and postoperative pain score (RR = 0.01, p < 0.01), the Er,Cr:YSGG laser had the most favorable result (P-score = 1.00). The Er: YAG laser demonstrated the highest probability of preventing recurrence (RR = 0.28, p < 0.01), followed by the diode laser (RR = 0.42, p < 0.01).

CONCLUSIONS

The choice of treatment for oral pigmentation should be based on individual patient needs and the desired outcomes. The Er: YAG laser seems highly effective in preventing pigment recurrence, the diode laser emerges as a top contender in managing bleeding risks, and the Er,Cr:YSGG laser is particularly efficacious in managing postoperative pain.

Congenital Melanotic Macule of the Tongue: Report of Two Cases and Literature Review

BACKGROUND

Congenital melanotic macule of the tongue (CMMT) has been described as a distinct entity, despite its unknown etiology. However, the diagnosis and management of affected newborns may challenge clinicians and pediatric dentists.

METHODS

We document here the clinicopathological findings of two additional cases of CMMT. A literature review of CMMT reports identified across PubMed, Web of Science, Embase, and Scopus was also conducted.

RESULTS

The patients, 2- and 4 month-old Venezuelan boys, respectively, presented at birth with a single or multiple dark-brown-pigmented macule exclusively on the dorsum of the tongue. Histopathological features revealed increased melanin pigmentation in the basal epithelial layer with overlying hyperkeratosis and pigment-laden subepithelial macrophages with normal morphological appearance. Nine studies comprising 17 cases of CMMT have been described hitherto. Most cases were from the USA and France (n = 6 each). Twelve (70.6%) patients were males, eight (50%) were white, and median age was 2.7 months. CMMT presented as brownish to black, solitary or multiple pigmentations located in the right or left region of the dorsum of the tongue, ranging in size from 3.0 to 30.0 mm.

CONCLUSION

An important feature for the diagnosis of CMMT is the information about the manifestation at birth and consequent proportional growth. This report intends to draw the attention of pediatricians and dentists to this apparently underdiagnosed condition for decision-making and management of affected newborns.

Global prevalence of oral pigmentation and its related factors: a systematic review and meta-analysis

BACKGROUND

Oral pigmentation is due to the accumulation of one or more pigments in tissues, causing changes in the color of the oral mucosal surfaces. Understanding the exact global prevalence of oral pigmentation and its associated factors helps researchers make the proper interventions at the right time; in this respect, the objective of the present systematic review and meta-analysis was to determine the global prevalence of oral pigmentation and its related factors.

METHOD

A systematic review and meta- analysis were conducted using the following databases: Magiran, SID, Scopus, Embase, PubMed, Web of Science (WoS), and Google Scholar. The search was run to retrieve articles published from inception until July 2021, and the following keywords were applied in the search strategy: "Epidemiolo*", "Prevalen*", "Factor*", "Pigment*", "Mouth", and "Oral". The I² index was used to assess the heterogeneity of the studies, and Egger's test was used to examine the publication bias.

RESULTS

Sixty-nine articles, with a sample size of 70,668 people, meeting the inclusion criteria were included in the study. The pooled of prevalence of oral pigmentation was estimated to be 20.8% (95% confidence interval: 17.1-1.25%). The prevalence of oral pigmentation raised significantly towards the end of the timespan covered by the study (P˂ 0.001). The majority of the examined studies reported that the prevalence of oral pigmentation is significantly higher in men, smokers or those exposed to secondhand smoke, people with fair skin, and who were affected by Yusho patients.

CONCLUSION

The results of the present study show that the prevalence of oral pigmentation is high, with higher prevalence in men, smokers or those exposed to cigarette smoke, people with fair skin, and Yusho patients compared to other groups. It is recommended that. these findings be used in policy makers' decisions to deliver better health care.

Unraveling the Risk Factors and Etiology of the Canine Oral Mucosal Melanoma: Results of an Epidemiological Questionnaire, Oral Microbiome Analysis and Investigation of Papillomavirus Infection

Simple Summary

Oral mucosal melanoma (OMM) is one of the most common oral cancers in dogs; however, the risk factors for its development remain obscure and the etiology is unknown. This study aimed to investigate the risk factors and etiology of OMM in dogs. An epidemiological questionnaire was applied to the owners of 15 dogs with OMM and their paired controls, and the oral microbiome was comparatively determined in the two groups. Additionally, the presence of papillomavirus was investigated in the same OMM samples. Most OMM and control dogs had grade 3 periodontal disease. No risk factors were identified through the epidemiological questionnaire, and papillomaviruses were not identified in the samples. The bacteria Tannerella forsythia and Porphyromonas gingivalis were significantly overrepresented in dogs with OMM, and their presence could be considered a risk factor for the development of canine OMM.

Abstract

Oral mucosal melanoma (OMM) is the most common oral cancer in dogs and is very aggressive in this species; its risk factors and etiology are yet to be determined. This study aimed to unravel the risk factors for the development of OMM in dogs and to investigate the possible presence of papillomaviruses as an etiological factor. A case-control study was conducted in 15 dogs with OMM and 15 paired controls whose owners answered an epidemiological questionnaire. Oral swabs from the same dogs were subjected to 16S rRNA sequencing for microbiome analyses. In addition, DNA fragments of OMM had their DNA extracted and amplified by polymerase chain reaction in an attempt to detect canine papillomaviruses. The gingiva was the most frequent anatomical site (47%) of OMM, and most tumors were stage III when diagnosed. Most dogs bearing OMM and the controls had grade 3 periodontal disease, and this factor, along with tartar treatment and tooth brushing, did not differ between cases and controls. Most dogs with OMM and most controls had contact with smokers; there was no statistically significant difference. Canine papillomaviruses were not detected among OMM cases. Tannerella forsythia and Porphyromonas gingivalis were significantly increased in case dogs compared to the controls. As these bacteria are reportedly involved in the pathogenesis of periodontal disease and esophageal cancer in humans, we suggest that they might be risk factors for the development of canine OMM. The limitations of this study include the low number of dogs, and therefore, further studies on canine OMM with larger numbers of animals are encouraged.

Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Tumours of the Oral Cavity and Mobile Tongue

The fifth chapter of the upcoming fifth edition of the 2022 World Health Organization Classification of Tumours of the Head and Neck titled Tumours of the oral cavity and mobile tongue, has had some modifications from the 2017 fourth edition. A new section "Non-neoplastic Lesions", introduces two new entries: necrotizing sialometaplasia and melanoacanthoma. The combined Oral potentially malignant disorders and Oral epithelial dysplasia section in the 2015 WHO has now been separated and submucous fibrosis and HPV-associated dysplasia are also discussed in separate sections. Carcinoma cuniculatum and verrucous carcinoma are described in dedicated sections, reflecting that the oral cavity is the most common location in the head and neck for both these entities which have distinct clinical and histologic features from conventional squamous cell carcinoma. This review summarizes the changes in Chapter 5 with special reference to new additions, deletions, and sections that reflect current clinical, histological, and molecular advances.

Pigmented Oral Lesions: A Multicenter Study

Objectives  The aim of this study was to determine the prevalence and clinical features of pigmented oral lesions from Thailand.

Materials and Methods  Biopsy records of the Department of Oral Pathology, Chulalongkorn University, Department of Oral Diagnosis, KhonKaen University, Department of Oral Biology and Oral Diagnostic Sciences, Chiangmai University, Department of Stomatology, Prince of Songkla University, and Rangsit University were reviewed for oral pigmented lesions diagnosed during 1999 to 2019. Demographic data were culled from the biopsy records. Ages of the patients were subdivided into 10-year intervals. Locations of the lesions were classified as gingiva, labial/buccal mucosa, palate, floor of the mouth, tongue, as well as the combination of sites. Data were analyzed by descriptive statistics using SPSS version 20.0.

Results  Of the 47,175 accessioned cases, 241 cases (0.51%) were diagnosed in the category of pigmented oral lesions. The age of the patients ranged from 1 month to 88 years with the mean ± standard deviation = 38.74 ± 20.96 years. Regarding gender, 172 patients (71.37%) with pigmented lesions were females, while 69 patients (28.63%) were males. The female-to-male ratio was 2.49:1. The majority of the pigmented lesions were encountered at the gingiva (29.88%) followed by labial/buccal mucosa (26.97%), palate (14.94%), lip (10.79%), alveolar mucosa (9.54%), and others (7.88%), respectively. The three most common pigmented oral lesions in the present study were nevus (39.83%), followed by melanotic macule (28.63%) and amalgam tattoo (17.43%), respectively.

Conclusions  The most common pigmented oral lesion in the present study is nevus. Demographic data of the patients in the present study are in accordance with previous studies with minor differences. Even though pigmented lesions of the oral cavity constitute a small portion of the oral pathology biopsies, accurate diagnosis is important since there is an overlap in clinical appearance of benign pigmented lesions and melanoma.

Primary melanoma of the oral cavity: A multi-institutional retrospective analysis in Brazil

Background

Melanoma is an aggressive malignant tumor, rarely observed in the oral cavity. The aim of this study was to describe the clinicopathologic features of a series of oral melanomas.

Material and Methods

A retrospective descriptive study was performed. A total of 15,482 biopsy records from two oral and maxillofacial pathology services in Brazil were analyzed. All cases of oral melanomas were reviewed, and clinical, demographic, histopathological data, treatment, and follow-up status were collected. In addition, immunohistochemistry stains (pan-cytokeratin AE1/AE3, vimentin, α-SMA, CD45, S-100 protein, HMB-45, Melan A, and Ki-67) were performed.

Results

The series comprised of 5 males (71.4%) and 2 females (28.6%), with a mean age of 58.0 ± 9.2 years (range: 45-69 years) and a 2.5:1 male-to-female ratio. The gingiva (n = 3, 42.8%) and hard palate (n = 2, 28.6%) were the most common affected sites, presenting clinically as ulcerated swellings with a brown to black color. Cervical lymph node metastasis was detected in three patients during the first examination. Microscopically, 6 cases (85.7%) were melanotic, and one (14.3%) was amelanotic. Most cases (n = 4, 57.1%) presented a predominance of epithelioid cells. S-100 and HMB-45 were positive in all cases (n = 7, 100.0%). In contrast, only 4 cases (57.1%) were positive for Melan-A. The proliferative index with Ki-67 was high, with labeling index ranging from 70.0% to more than 90% of positive cells. Five patients died from complications of the tumors after a mean follow-up period of 7.8 months.

Conclusions

Melanoma is an aggressive malignant tumor that rarely occurs in the oral cavity. It occurs mainly in adult and elderly patients and often is diagnosed in advanced stages. The current findings were similar to previous studies and reflected the characteristics of the services from where lesions were retrieved.

Key words:Head and neck cancer, melanoma, oral melanoma, oral mucosa.