Case #16 Discussion

Summary: This is a localized pigmented surface lesion of the oral mucosa Lesions to Exclude from the Differential Diagnosis: Intravascular blood lesions   ~Blanch upon pressure   ~Color – red, blue or purple Extravasated blood lesions   ~Red, Blue or Purple, not brown Ephelis   ~Flat and not thickened   ~Occurs only on sun-exposed skin Oral Melanotic Macule   ~Flat and not thickened Lesions to Include in the Differential Diagnosis: Nevus   ~Raised and smooth   ~Brown to tan in color Melanoma   ~Since the patient is so young, this lesion is unlikely Tattoo   ~Cannot be excluded because it could be due to amalgam or graphite from a lead pencil Hematoma   ~Cannot be excluded even though there is no history of trauma because trauma in the mouth during eating can occur without a history, especially for children. Management: Excisional biopsy is indicated for any lesion in which nevus or melanoma are included in the differential diagnosis.  Explain the differential diagnosis to the patient and parents and the indications for biopsy.  Melanoma in a child is rare but must still be considered. Final Diagnosis: Tattoo from graphite due to traumatic implantation of pencil lead