and oral mucosa. The patient first noticed a lesion on her lower lip in 2012, followed
by the development of the intraoral lesions in 2019. She stated that she was unhappy
with the appearance of the lip and gingival macules. Her medical history included
systemic lupus erythematosus (SLE) diagnosed in 2012, rheumatoid arthritis diagnosed
in 2018, hypertension, anemia, and seizures. Her medications included hydroxychloroquine,
losartan, duloxetine, gabapentin, and prednisone (as needed). Clinical examination
revealed variably sized pigmented macules on the lips, gingiva, buccal mucosa, and
hard and soft palate (Figure 1, Figure 2, Figure 3). The macules displayed variable intensity of pigmentation. An incisional biopsy
was performed of a lesion on the maxillary facial gingiva and microscopic examination
revealed features consistent with a melanotic macule (Figure 4).
Figure 1Multiple brown-gray macules on the buccal mucosa and soft palate.
Figure 2Well-demarcated brown-gray macules on the hard palate.
Figure 3Multiple gray macules on the lower labial mucosa.
Figure 4Brown pigment within macrophages in the superficial lamina propria. Increased melanin
is seen in the basal layer of the epithelium (hematoxylin-eosin, magnification ×20).
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Biography
Dr. Ruddocks is a resident, Oral and Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL.
Biography
Dr. Bhattacharyya is a division director, Oral and Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL.
Biography
Dr. Cohen is a department chair, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL.
Biography
Dr. Islam is a program director, Oral and Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL.
Biography
Dr. Roca is a board certified periodontist, Orlando, FL.
Article Info
Publication History
Published online: September 03, 2022
Publication stage
In Press Corrected Proof
Footnotes
Disclosures. None of the authors reported any disclosures.
Diagnostic Challenge is published in collaboration with the American Academy of Oral and Maxillofacial Pathology and the American Academy of Oral Medicine.
Identification
DOI: https://doi.org/10.1016/j.adaj.2022.06.015
Copyright
© 2022 American Dental Association. All rights reserved.
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