Oral melanoacanthoma with prominent spongiotic intraepithelial vesicles

Multifocal Intraoral Melanoacanthomas: Two Case Reports and a Literature Review

Intraoral melanoacanthoma is a rare, reactive pigmented lesion that is mostly seen in black individuals with a tendency to occur more frequently in younger females. The color of melanoacanthoma may vary from brown to black, and it is commonly seen as a solitary lesion in the buccal mucosa. This lesion requires no treatment, and no malignant potential has been observed to date. The clinical presentation of multifocal oral melanoacanthoma (MOMA) (the rate of growth and the recurrence) is usually diagnostic. On the other hand, solitary oral melanoacanthoma might be difficult to diagnose, and a biopsy should be performed and examined by a well-trained oral pathologist. Here, we report two cases of MOMA with an unusual location in one case.

Pathogenesis and clinicohistopathological caractheristics of melanoacanthoma: A systematic review

Introduction

The melanoacanthoma is a rare benign pigmented tumor, characterized by a fast radial growth and clinical behavior similar to melanoma. Color changes in oral mucosa and dermis are consequence of increased melanocyte activity as response to an irritant factor. There is a vast phenotypic variety. It is difficult to distinguish between a benign pigmented lesion and a melanoma at its early stage. Due to its clinical relevance is crucial to diagnose possible malignancy of the lesions.

Objectives

The aim of this article is to conduct a systematic review of all published articles, as well as update and evaluate etiologic factors and clinicopathological features.

Material and Methods

We carried out a search in the Medline database (PubMed) using the key words “oral melanoacanthoma” AND “oral melanoacanthosis” AND “oral melanoepithelioma”. Inclusion criteria were all published articles since its discovery. Demographic data, histological features and immunohistochemical findings were extracted from the full articles.

Results

A total of 56 articles were analysed. 114 injuries drawn from these articles were studied, a total of 115 injuries with our contribution case. The 74.78% of authors claim a reactive pathogenesis. The average age of lesión appearance is 34.79 years, with an age range of 5-87 years. There is a predominance of the female sex in solitary phenotype 3: 2 and a ratio of women to men 5: 3 if it is multifocal phenotype. Bilateral phenotype is slight higher in women of 2: 1.

Conclusions

Histopathological analysis of the lesión is vital to diagnose malignancy. Therefore, any heterogeneous, pigmented lesion with irregular edges, raised surface, fast growth and abrupt appearance should be biopsied. More emphasis on the potential irritants should also be put to improve the quality of life of our patients and to reduce morbidity of melanoacanthoma, as well as, several similar clinical behavior disease.

Key words:Melanoacanthoma, oral cáncer, diagnosis.

Oral Melanoacanthoma: A Case Report, a Review of the Literature, and a New Treatment Option

Objectives:

Oral melanoacanthoma is a rare condition that presents as a pigmented, painful lesion, most commonly on the buccal mucosa. Argon plasma coagulation is a new treatment option for benign oral lesions and is hypothesized to be efficacious for this rare mucosal disorder.

Methods:

Treatment of a case and a review of the English-language literature were performed.

Results:

One patient received a diagnosis of oral melanoacanthoma, and argon plasma coagulation treatment resulted in ablation of the lesion with excellent mucosal healing. A review of the literature demonstrated that this lesion is most commonly associated with black (90.9%), adult female (69.7%) patients and is most commonly located on the buccal mucosa (64.7%).

Conclusions:

Oral melanoacanthoma is a rare, benign mucosal lesion that may require surgical intervention for symptomatic relief. Argon plasma coagulation is a relatively safe and effective means of treating this lesion. Argon plasma coagulation treatment may be expanded to include other benign, superficial lesions of the oral mucosa.

Misnomers in dermatology: an update

The name of a condition in dermatology, gives a clue regarding the clinical feature, etiology, or histopathology of the disease. A disease might have been termed wrongly due to its resemblance to another known condition. Misnomers often mislead a physician regarding the etiology or histopathology of the condition. Here is a list of misnomers, with explanation, and the appropriate name in parentheses.

Multifocal oral melanoacanthoma and melanotic macula in a patient after dental implant surgery

BACKGROUND

Oral melanoacanthoma (OMA) is an uncommon, reactive, pigmented mucocutaneous lesion. It is a rapidly growing, well-circumscribed, small, brown-to-black, solitary or multifocal macule that is characterized histopathologically by proliferation of keratinocytes and pigment-laden dendritic melanocytes.

CASE DESCRIPTION

At the end of a one-month healing period after dental implant surgery, a 63-year-old white woman had pigmented lesions at different oral mucosal sites (hard palate, buccal mucosa and left maxillary tuberosity) that showed macrophages exhibiting iron and melanin in multiple areas of the lamina propria. The authors obtained biopsy specimens from all the lesions for histologic and immunohistochemical analyses and light-microscopy study.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Surgery could have been causal or incidental to the appearance of these lesions. Clinicians should be aware of this possible event and make a correct and pathologically confirmed differential diagnosis.

Oral melanoacanthoma: a case report and review of the literature

INTRODUCTION

Oral melanoacanthoma is a rare, benign pigmented lesion characterized clinically by the sudden appearance and rapid growth of a macular brown-black lesion and histologically by acanthosis of the superficial epithelium and proliferation of dendritic melanocytes.

CASE PRESENTATION

We present a case report of oral melanoacanthoma in a 24-year-old Asian Indian man. He presented with an intra-oral brown macular lesion on the left buccal mucosa with a duration of one and a half months. Microscopic examination revealed acanthosis of stratified squamous surface epithelium and dendritic melanocytes diffusely distributed in the epithelium; the Masson-Fontana silver impregnation technique was used to demonstrate the dendritic melanocytes. Based on the history, clinical features and histological presentation, the lesion was diagnosed as melanoacanthoma.

CONCLUSION

This is the first reported instance of oral melanoacanthoma in the Indian sub-continent. This report details the course of the lesion from diagnosis to its resolution. Melanoacanthoma must be differentiated from other intra-oral pigmented lesions and biopsy may be required to rule out melanoma.

Oral melanoacanthoma: a report of 10 cases, review of the literature, and immunohistochemical analysis for HMB-45 reactivity

Oral melanoacanthoma (MA) is rare reactive mucosal lesion that, like cutaneous MA, demonstrates hyperplasia of spinous keratinocytes and melanocytes. Unlike MA of the skin, oral MA is unrelated to seborrheic keratosis. This series adds 10 cases to the limited number of previous reports of oral MA. The clinicopathologic features of the cases in this series are generally consistent with those previously reported in the literature; that is, although documented in various intraoral locations in patients of differing ethnicity, oral melanoacanthoma most often presents as an enlarging flat or slightly raised area of hyperpigmentation on the buccal mucosa of adult black women. The current series provides evidence of occurrence over a wider age range (5-77 years) than previously reported. Additionally, the reactivity of oral melanoacanthoma to HMB-45 was investigated. Strong HMB-45 reactivity was present in all cases, thus demonstrating its limited utility in distinguishing oral MA from malignant melanoma.

Minocycline-induced hyperpigmentation of the tongue: successful treatment with the Q-switched ruby laser

BACKGROUND

Minocycline-induced hyperpigmentation (MIH) is a benign condition that may persist for years despite abrogation of therapy. The Q-switched ruby laser (QSRL) has been successful in removing such lesions from the skin. To date there is no documentation of QSRL or any laser being used to treat lingual hyperpigmentation associated with minocycline therapy.

OBJECTIVE

Long-term follow-up results are reported for the use of QSRL to treat lingual hyperpigmentation. The literature is reviewed comparing the use of different laser systems on MIH.

METHODS

A 26-year-old woman with pigment changes of the tongue and buccal mucosa due to long-term minocycline therapy was treated with four consecutive sessions with QSRL (694 nm, 20-nsec pulse duration, and 6.5 mm spot size) at 3.6-4.0 J/cm2.

RESULTS

A 90% resolution was achieved after three treatments. After the final treatment the lesions were completely gone. There were no side effects reported. No new pigment was detected at follow-up.

CONCLUSION

Treatment with the QSRL is a safe and effective strategy for treating hyperpigmentation of the tongue associated with minocycline therapy.

Pigmented squamous cell carcinoma with dendritic melanocytes

A 79-year-old man presented with a pigmented nodule on the right ear which, on epiluminescence microscopy, demonstrated a diffuse grey-blue colour. Skin biopsy revealed an irregularly acanthotic epidermis with lobular clusters of atypical keratinocytes that projected into the dermis in the pattern of an invasive squamous cell carcinoma. Numerous dendritic melanocytes were present throughout the lesion. Although the close relationship between the highly dendritic intra-epidermal melanocytes and the atypical keratinocytes raised the issue of whether this tumour represented a malignant melanoacanthoma, the authors considered the lesion to be better classified as an unusual variant of pigmented squamous cell carcinoma.