This Masterclass provides a structured clinical framework for assessing pigmented lesions of the oral mucosa
Oral mucosal color varies by keratinisation, melanocyte activity, melanin deposition, vascularity, and submucosal tissue type.
Pigmentation may appear brown, black, blue, or grey, depending on depth and pigment type, including melanin or hemosiderin.
Clinical guidance
All pigmented lesions should be treated with caution—some authors even recommend regarding unexplained lesions as melanoma until proven otherwise.
A logical, step-wise approach is essential for diagnosis.
Categories covered
✔ Diffuse physiological pigmentation
Common among darker-skinned populations, typically symmetrical and benign (e.g. gingiva, buccal mucosa, tongue); no treatment needed.
✔ Localized lesions
Includes lesions such as melanotic macules, oral nevi, smoker’s melanosis, and amalgam tattoos—each with distinct clinical features and varying management strategies.
✔ Mucosal melanoma
Although rare, this should be considered in any evolving pigmented lesion. It most often affects the palate and maxillary gingiva, may arise de novo or from long-standing pigmentation, and has poor prognosis unless detected early.
Management recommendations
✔ Meticulous history and lesion documentation (size, symmetry, color, duration).
✔ Use clinical photography and regular monitoring.
✔ Biopsy or specialist referral whenever etiology is uncertain—especially for focal or changing lesions. Early detection of melanoma dramatically influences outcome.
I encourage dentists worldwide to download and Review this valuable PDF guide—it offers a quick, evidence-based reference for the evaluation and management of pigmented oral lesions.
