Case #15 Discussion

Summary: This is a localized pigmented surface lesion of the oral mucosa   ~Blue to black color with irregular borders   ~Varies from flat to thickened   ~Consists of multiple pigmented areas within a localized region   ~Does not blanch Lesions to Exclude from the Differential Diagnosis: Tattoo   ~Does not present with variable thickness, color and multiple areas unless history of  major trauma, such as shrapnel or motor vehicle accident Intravascular Lesions   ~Blanch upon pressure Ecchymosis and Petechiae   ~Flat Hematoma and Thrombosed Varix   ~Not fixed to the underlying structures   ~No history of trauma Ephelis, Nevus, Oral Melanocytic Macule   ~Do not vary in color or thickness   ~Not that large   ~Are symmetrical Lesions to Include in the Differential Diagnosis Melanoma   ~Asymmetry and irregular borders   ~Variation in color   ~Variation in thickness   ~Diameter greater than 6 mm with multiple areas Management: The irregular clinical appearance of a large pigmented lesion is very suggestive of melanoma.  Explain your suspicions about the lesion to the patient, and refer to an oral surgeon or physician as soon as possible for incisional biopsy.   The fact that this lesion is thickened and fixed to underlying structures in mucosa that are normally not attached (soft palate), indicates that it is an advanced lesion.  Final Diagnosis: Melanoma