Open Access
Issue
Med Buccale Chir Buccale
Volume 23, Number 2, Juin 2017
Page(s) 119 - 120
Section Cas clinique / Short case report
DOI https://doi.org/10.1051/mbcb/2016064
Published online 15 September 2017

© The authors, 2017

Licence Creative Commons
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1 Observation

1.1 Case 1

A 53-year-old man (Fig. 1A) consulted use after the incidental discovery of a 5-mm papule circumscribed by a blue halo on the left hard palate adjacent to tooth 26 (Fig. 1). He had an unremarkable history, did not take any medication, and was under smoking cessation after 2 years of an estimated consumption of at 25 pack-years. There was no cervicofacial lymphadenopathy. Panoramic X-ray did not show any abnormalities. Lesion excision was performed under local anesthesia with healthy margins. Histology showed fascicle clusters of fusiform, highly pigmented melanocytes, arranged in the medium and deep soft tissue (Fig. 2A). There was no nuclear atypia or anomalous mitotic activity. Positive staining for Melan A and Ps100 confirmed the proliferation of melanocytes (Fig. 2B). The findings suggested the diagnosis of a blue nevus. Excision was complete.

thumbnail Fig. 1

Clinical images of blue nevi with a palatal location. (A) case 1 and (B) case 2.

thumbnail Fig. 2

Histological section of the palatine mucosa in case 2. Fascicular clusters of melanocytes are located in the medium and deep soft tissue. Arrow = cluster ((A) HES ×100 and (B) protein IHC S-100 ×200).

1.2 Case 2

A 60-year-old woman (Fig. 1B) with an unremarkable medical history consulted us after the recent discovery of a left palatal lesion. Clinical examination found a benign bluish macule. There was no lymphadenopathy. The excision performed under local anesthesia confirmed the diagnosis of a blue nevus. The histological findings were similar to those in the first case.

2 Discussion

Oral pigmentations have several origins and can be either melanic and nonmelanic. Melanocytes are naturally arranged between keratinocytes in the basal layer of the oral epithelium, without contact between them [1]. Unlike melanin macules, which are associated with pigmentary incontinence, and lentigines, which correspond to a proliferation of melanocytes that remain isolated, nevi are melanocytic tumors formed by the proliferation of melanocytes grouped into theca cells [2,3]. The position of the melanocytic proliferation in the mucosal tissue allows the differentiation of nevi from mucous, junctional, compound, or blue nevi [2,3]. These lesions are rare in the oral cavity, where their incidence is 4 per 10 million people/year [13]. They develop as pigmented papules of size 0.1–3 cm, sometimes with a macular appearance [1,2]. A palatal location seems to be the most frequent [2], followed by the labial and the buccal mucosa [2,3]. Nevus color ranges from black, gray, brown, blue, to colorless (2, 4, 5), and this colorless variety is linked to greater depth of melanocytic proliferation. Blue nevi represent 23% oral nevi [2]. They show an atypical shape because the highly pigmented fusiform melancoytes are not grouped into theca cells and are arranged more deeply in the connective tissue parallel to the epithelial surface [2]. Differential diagnosis of nevi should be made with the other causes of oral mucosa pigmentation: (i) exogenous (ethnic or metal tattoo, drug pigmentation or vascular lesion); (ii) endogenous (hypermelanosis or hypermelanocytosis, whether or not related to systemic signs) [1,4]. Some nevi may be clinically atypical; therefore, it is essential to remove melanomas even if they occur as single lesions. The ABCDE criteria (A: asymmetry, B: borders, which tend to be uneven, C: color, which are nonhomogeneous, D: diameter, which tends to be large, E: evolution of the lesion) for cutaneous melanoma can also be applied to oral mucosal nevi [1]. Nevertheless, nevi evolution to melanoma is exceptional [5]. Excision and histopathological analysis of an idiopathic, solitary lesion should be mandatory [3].

Conflicts of interest:

The authors declare that they have no conflicts of interest in relation to this article.

References

  1. Meleti M, Vescovi P, Mooi WJ, van der Waal I. Pigmented lesions of the oral mucosa and perioral tissues: a flow-chart for the diagnosis and some recommendations for the management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:606–616. [CrossRef] [PubMed] (In the text)
  2. Ferreira L, Jham B, Assi R, Readinger A, Kessler HP. Oral melanocytic nevi: a clinicopathologic study of 100 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;120:358–367. [CrossRef] (In the text)
  3. Cloitre A, Boralévi F, Fricain JC. Nævus mélanocytaire composé palatin chez un enfant de 3 ans. Med Buccale Chir Buccale 2015;21:43–44. [CrossRef] [EDP Sciences] (In the text)
  4. Fernandes D, Ferrisse TM, Navarro CM, Sgavioli Massucato EM, Onofre MA, Bufalino A. Pigmented lesions on the mucosa: a wide range of diagnoses. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119:374–378. [CrossRef] (In the text)
  5. CEDEF. 2015 Tumeurs cutanées épithéliales et mélaniques: nævus. Annales de Dermatologie et de Vénéréologie 2012;139:A158–A163. [CrossRef] (In the text)

All Figures

thumbnail Fig. 1

Clinical images of blue nevi with a palatal location. (A) case 1 and (B) case 2.

In the text
thumbnail Fig. 2

Histological section of the palatine mucosa in case 2. Fascicular clusters of melanocytes are located in the medium and deep soft tissue. Arrow = cluster ((A) HES ×100 and (B) protein IHC S-100 ×200).

In the text

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