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Case Report

Multiple melanotic macules of unknown origin S. Sutera, F. Astolfi, G. Mariani, E. Baruzzi, A. Sardella UO Dentistry II – AO San Paolo Hospital Milan, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy Introduction. Melanotic macules are localized deposits of melanin without an increasing in the number of melanocytes. They are frequent in females between 40 and 50 years of age, with a preferential localization on lips, gingiva, buccal mucosa and palate. Case details. A 41-year-old woman was sent to the Unità Complessa di Odontostomatologia II of the Ospedale San Paolo di Milano for oral specialist medicine assessment about intraoral multiple pigmentations. The patient was a no smoker-woman, who only made use of birth control pills. She reported that the pigmentation of the labial mucosa appeared about 5 years before, while intraoral pigmented were observed, for the first time by her dentist a month before. She also complained discomfort and burning of the upper labial mucosa.

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At physical examination, multiple melanotic macules of lips, lingual margins, hard palate and buccal mucosa could be detected. We carried out an incisional biopsy which allowed the histopathologic diagnosis of “melanotic macule.” During follow-up visits, the patient reported increasing burning and pain at the site of biopsy, and she also showed an increasing number of lesions and intensification in colour of pre-existing labial ones. Blood tests did not show abnormal values. Conclusions. Melanotic macule may appear, together with other signs, in several syndromes or following the use of drugs, but sometimes their origin remains unclear. In the clinical case here described, multiple pigmented lesions were not associated with other abnormalities of the skin, nails or blood values. Pharmacological anamnesis documented the intake of birth control pills, but only after the appearance of the maculas. Biopsy allowed the diagnosis of melanotic macules without, however, correlate with any other syndromes. References • •

Gondak RO, da Silva-Jorge R, Jorge J, Lopes MA, Vargas PA. Oral pigmented lesions: Clinicopathologic features and review of the literature. Med Oral Patol Oral Cir Bucal. 2012;17:e919-24. Meleti M, Vescovi P, Mooi WJ, van der Waal I. Pigmented lesions of the oral mucosa and perioral tissues: a flow-chart for the diagnosis and some recommendations for the management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:606-16.

Annali di Stomatologia 2013; Suppl. 2: 1-48

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Multiple melanotic macules of unknown origin.

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