Dermoscopy and Pigmented Lesions of Oral Cavity

Year 2017, Volume: 17 Issue: 3, 189 - 191, 27.09.2017

Manas Bajpai Nilesh Pardhe

https://doi.org/10.17098/amj.339336

Cited By: 2

Abstract

Dear
editor,

Pigmented
lesions are relatively rare in the oral cavity. They represent a variety of
entities ranging from racial pigmentation to manifestation of systemic illness
(Addison’s disease), to benign (hemangioma, lymphangioma, melanotic nevi) and
malignant neoplasms (Kaposi’s sarcoma, malignant melanoma, pigmented basal cell
carcinoma).¹ Biopsy is usually avoided in vascular lesions like hemangioma,
Kaposi’s sarcoma etc. by general dentists owing to the risk of excessive
bleeding due to the possibility of their association with a feeder vessel. A
color Doppler ultrasonography is sometime required in order to rule out this
association; otherwise sclerosing agents are used for diagnostic and
therapeutic purposes.²

Melanotic
lesions like malignant melanoma or melanotic nevi are sometimes seen in the
oral cavity; some clinicians believe that incisional biopsy of a melanoma might
disseminate the disease.³  

A
guideline of biopsy taking for melanoma has been issued. It includes a full
thickness excisional biopsy allowing assessment of the Breslow thickness, but
preliminary biopsies are only advisable in case of acral melanoma; however,
shave and punch biopsy are no more recommended, but hesitation of clinicians
for taking biopsy from pigmented lesions cannot be ignored. ⁴

 Dermoscopy is a non – invasive technique that
allows a visualization of morphological features of the lesion that are not
visible to a naked eye. This is useful in dermatology for making an early
differential diagnosis of different pigmented lesions.⁵ Despite
their popularity in dermatology, they are not very popular in investigation of
the mucosal lesions of lip and oral cavity.⁶ Dermoscopy can be
extremely helpful in making demarcation between melanotic nevi and malignant
melanoma (Figure 1).

There
is a need to intensify the research pertaining to the use of dermoscopy in oral
mucosal lesions, also a criterion has to be introduced for the diagnosis of
oral pigmented lesions on dermoscopy.  It
minimizes the risk of the exposure of the patient to excisional biopsy that may
be resulting in facial disfigurement. This procedure can be easily adopted by
dentists working in private sectors and corporate sectors. Dental curriculum
has to be enhanced with the use of dermoscopes in diagnosing pigmented oral
lesions on graduate and post-graduate level.   

References

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• Bajpai M, Pardhe N, Chandolia B. Malignant melanoma of oral cavity J Ayub Med Coll Abbottabad 2017;29(1):183.
• Brown SJ, Lawrence CM. The management of skin malignancy: to what extent should we rely on clinical diagnosis? Br J Dermatol 2006;155:100–3.
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