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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 878-880  

A focal intrinsic physiologic pigmentation of tongue


1 Krishna Dental Clinic, Erode, Tamil Nadu, India
2 Department of Oral Medicine and Radiology, Karpaga Vinayaga Institute of Dental Sciences, Kanchipuram, Tamil Nadu, India

Date of Submission19-Nov-2020
Date of Acceptance24-Nov-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Kalaiselvi Santhosh
Department of Oral Medicine and Radiology, Karpaga Vinayaga Institute of Dental Sciences, Kanchipuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_745_20

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   Abstract 


Pigmentation is defined as the process of deposition of pigments in the tissues. It can be endogenous or exogenous in origin and may be physiological or pathological. Pigmentation is a common intraoral finding; various diseases can lead to varied discolorations of the mucosa. Diagnosis of pigmented lesions of the oral cavity is a challenging task, therefore understanding of the causes of mucosal pigmentation and appropriate evaluation of the patient are essential in the diagnosis of the pigmented lesions.

Keywords: Endogenous, intrinsic, pigmentation


How to cite this article:
Radhakrishnan S, Santhosh K, Anbuselvan GJ, Kanthasamy G. A focal intrinsic physiologic pigmentation of tongue. J Pharm Bioall Sci 2021;13, Suppl S1:878-80

How to cite this URL:
Radhakrishnan S, Santhosh K, Anbuselvan GJ, Kanthasamy G. A focal intrinsic physiologic pigmentation of tongue. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Oct 27];13, Suppl S1:878-80. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/878/317664




   Introduction Top


The term “oral pigmentations” includes a large group of conditions represented by the accumulation of one or several types of pigments, thus causing color changes in the oral mucosa.[1] Exogenous pigmentation is commonly due to foreign-body implantation in the oral mucosa. Endogenous pigments are due to melanin, hemoglobin, hemosiderin, and carotene.[2] Blue, brown, and black discolorations constitute the pigmented lesions of the oral mucosa and such color changes can be due to the deposition of either endogenous or exogenous pigments.[2],[3] Diagnosing a patient with a pigmented lesion should include detailed medical and dental history and extraoral and intraoral examinations. Biopsy and laboratory investigations are required to establish a definite diagnosis.


   Case Report Top


A 65-year-old male patient presented with a chief complaint of pain in the lower right posterior tooth region for 15 days. The pain was mild, was pricking type, and aggravates while chewing food, and the patient was not taking any medications for the same. His past dental, medical, surgical, and personal histories were not contributory.

Extraoral examination revealed no significant changes. The lymph nodes were not palpable. Intraoral examination showed dental caries with Grade II mobility in 46. Soft-tissue examination of the tongue showed a well-demarcated, smooth, dark brownish-black pigmented lesion, present on both sides of the dorsolateral border of the tongue, measuring approximately 5–2 cm in diameter [Figure 1]. No other marked deformity or pigmented lesion was noted on thorough systemic examination.
Figure 1: Pigmentation on the dorsal surface of the tongue

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The differential diagnosis for brownish pigmentation depends on whether the lesion is focal (melanotic macule, nevus, and melanoma), diffuse (ecchymosis, melanoma, and drug induced), or multifocal (physiologic pigmentation, drug induced, and oral lichen planus). Most of the pigmentations are benign, but sometimes they can be malignant. After assessing the patient's history, systemic condition, and clinical findings, a diagnosis of physiologic melanin pigmentation was made.


   Discussion Top


Mucosal epithelium of the oral cavity is not uniformly colored, and several degrees of chromatic variation may be observed in physiologic and pathologic conditions.[4] Oral pigmentation has been associated with a variety of endogenous and exogenous etiologic factors.[5],[6],[7] Most of the pigmentation is caused by five primary pigments, which include melanin, melanoid, oxyhemoglobin, reduced hemoglobin, and carotene. Others are caused by bilirubin and iron.[1],[2],[4],[6],[7],[8]

Melanocytes were first identified in the oral epithelium by Becker in 1927; head-and-neck region is the first site of the body where melanocytes appear after approximately 10 weeks of gestation.[5],[6] During early intrauterine life, the precursors of melanocytes, melanoblasts, migrate from the neural crest to the epidermis and the hair follicles, becoming differentiated into dendritic cells.[9],[10],[11],[12]

Physiologic pigmentation, very common in African, Asian, and Mediterranean populations, is due to increased melanocyte activity rather than an increased number of melanocytes.[1] Physiologic pigmentation develops during the first decades of life but may not come to the patient's attention until later.[1] The color ranges from light to dark brown and affects both males and females with no significant differences in the distribution.[8],[13] Oral pigmentations are mostly physiological and genetically determined. Attached gingiva is the common intraoral site for pigmentation; they appear bilaterally with well-demarcated, ribbon-like, dark brown band that usually spares the marginal gingiva.[7] Pigmentation of the buccal mucosa, hard palate, lips, and tongue may also be seen as brown patches with ill-defined borders. The physiologic pigmentation is asymptomatic, and no treatment is required.[2],[14]

The differential diagnosis of brownish pigmentation includes ecchymosis, drug induced, oral lichen planus, physiologic pigmentation, melanotic macule, nevus, and melanoma.[7] The differential diagnosis of brownish pigmentation includes ecchymosis, drug induced, oral lichen planus, physiologic pigmentation, melanotic macule, nevus, melanoma, Peutz–Jeghers syndrome (associated with intestinal polyposis), Adisson's disease (chronic adrenal cortical insufficiency), Albright syndrome (polyostotic fibrous dysplasia), Von Recklinghausen disease (neurofibromatosis), hemochromatosis (resulting from faulty metabolism of iron), and acanthosis nigricans.[7] Dark pigmentation is because of intoxification with a range of heavy metals such as mercury, silver, and lead. Certain drugs such as antimalarials (quinolines), antibiotics (minocycline), and chemotherapeutic agents (doxorubicin) may also produce black pigmentation of the oral mucosa.[1]

In the present case, the patient's past medical, dental, drug, and personal histories were evaluated which were not contributing. On intraoral examination, an extensive dark brownish, multifocal, flat pigmented lesion was present on the dorsal surface of the tongue. There was no change in color and size since many years. Based on the above findings, a diagnosis of physiologic melanin pigmentation was made.


   Conclusion Top


Diagnosis of oral pigmented lesions is a laborious task. Most of the oral pigmentations are physiologic, but, often, they can be a precursor of severe disease. Evaluation of patients with pigmented lesion should include a full medical and dental history and extraoral and intraoral examination and in some cases, biopsy and laboratory investigations are required for proper diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chandra S, Keluskar V, Bagewadi A, Sah K. Extensive physiologic melanin pigmentation on the tongue: An unusual clinical presentation. Contemp Clin Dent 2010;1:204-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Ciçek Y, Ertaş U. The normal and pathological pigmentation of oral mucous membrane: a review. J Contemp Dent Pract 2003;4:76-86.  Back to cited text no. 2
    
3.
Gaeta GM, Satriano RA, Baroni A. Oral pigmented lesions. Clin Dermatol. 2002;20:286-8.  Back to cited text no. 3
    
4.
Gondak RO, Da Silva-Jorge R, Jorge J, Lopes MA, Vargas PA. Oral pigmented lesions: Clinicopathologic features and review of the literature. Med Oral Patol Oral Cir Bucal 2012;17:e919-24.  Back to cited text no. 4
    
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Ghapanchi J, Darvishi M, Tadbir AA, Derafshi R, Jokar S. Prevalence of oral pigmented lesions: A prospective study Aust. J Basic Appl Sci 2012;6:417-20.  Back to cited text no. 5
    
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Kauzman A, Pavone M, Blanas N, Bradley G. Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations. J Can Dent Assoc 2004;70:682-3.  Back to cited text no. 6
    
7.
Mallikarjuna K, Gupta S, Shukla S, Chaurasia S. Unusual extensive physiologic melanin pigmentation of the oral cavity: a clinical presentation. J Indian Soc Pedod Prev Dent 2013;31:121-125.  Back to cited text no. 7
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8.
Nisa SU, Saggu TK, Sangeetha R, Harchandani N. Pigmentation of oral cavity: A clinical enigma; A rare case report. J Indian Acad Oral Med Radiol 2016;28:342-5.  Back to cited text no. 8
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9.
Sbirkova T, Kisselov S, Cholakova R, Pechalova P, Konstantinova D. Focal oral pigmentation on the gingiva of mandible – A case report. J IMAB 2018;24:2193-5.  Back to cited text no. 9
    
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Sreeja C, Ramakrishnan K, Vijayalakshmi D, Devi M, Aesha I, Vijayabanu B. Oral pigmentation: A review. J Pharm Bioallied Sci 2015;7 (Suppl 2):S403-8.  Back to cited text no. 10
    
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Eisen D. Disorders of pigmentation in the oral cavity. Clin Dermatol 2000;18:579-87.  Back to cited text no. 11
    
12.
Hatch CL. Pigmented lesions of the oral cavity. Dent Clin North Am 2005;49:185-x.  Back to cited text no. 12
    
13.
Amir E, Gorsky M, Buchner A, Sarnat H, Gat H. Physiologic pigmentation of the oral mucosa in Israeli children. Oral Surg Oral Med Oral Pathol 1991;71:396-8.  Back to cited text no. 13
    
14.
Özbayrak S, Dumlu A, Ercalik-Yalcinkaya S. Treatment of melanin pigmented gingiva and oral mucosa by CO2 laser. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:14-5.  Back to cited text no. 14
    


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