melanosis4 Gingival melanoma
5 Racial pigmentation
Answers:
1 No
2 Smoker’s melanosis is confirmed by the dark gingival pigmentation especially on his anterior lower gingivae with a benign course and reinforced by yellow staining from nicotine on the middle and index finger nails, where his cigars were hold.
3 No
4 No
5 Having in mind the patient’s race (Caucasian) and his dark complexion, the gingival pigmentation could be attributed to racial pigmentation in addition to smoker's melanosis.
Comments: The characteristics of the patient's gingival pigmentation regarding the color (brown rather than blue or black), distribution (all gingivae and not ion‐free or mesio‐dental gingivae), type (band and not zone) in combination with the lack of recent exposure to toxic chemicals, exclude metal poisoning from the diagnosis. The homogeneity and not the gradation of brown discoloration, along with its morphology (plaque and not growth) or its progress (slow and not rapid) and lack of symptomatology and lympho‐adenopathy rule out oral melanoma from the diagnosis.
Q2 Which of the oral lesions below is/or are not related to smoking?
1 Leukoplakia
2 Nicotinic stomatitis
3 Hairy leukoplakia
4 Acute ulcerative gingivitis
5 Oral squamous cells carcinoma
Answers:
1 No
2 No
3 Hairy leukoplakia in contrast to hairy tongue lesion is not related to smoking. Hairy leukoplakia appears as a white corrugated lesion on the lateral margins of the tongue and is strongly related to Epstein‐Barr virus (EBV) infection in immunocompromised patients, which is partially responding to anti‐viral therapy.
4 No
5 No
Comments: Smoking can be involved in the pathogenesis of various oral lesions in several ways. The heat produced with smoking causes mouth dehydration, leading to difficulties in removal of dead epithelial cells (washing), retardation of the normal rate of desquamation on the dorsal surface of tongue, producing a hair‐like appearance which is susceptible to colonization of chromogenic bacteria as seen in a hairy‐coated tongue. The carcinogenic chemicals that are released with smoking damage the DNA, and delay the healing process, causing the accumulation of abnormal cells, with cancer development. Smoking provokes xerostomia, together with nicotine which induces gingival vasoconstriction. This as well as the impaired host immunity, enhances the pathogenic action of various bacteria in gingival diseases, especially in acute ulcerative gingivitis/stomatitis. The nicotine causes vasoconstriction of the palatal blood vessels and at the same time, the irritation of the mucosa from heat and various toxic irritants cause hypertrophy of the mucosa and inflammation of the ducts of minor salivary glands, as has been observed in nicotinic stomatitis.
Q3 Which of the tobacco chemicals below is/or are NOT related to cancer development?
1 Nicotine
2 Polycyclic aromatic hydrocarbons (PAHs)
3 Essence oils
4 Herbs
5 Nitrosamines
Answers:
1 No
2 No
3 Essence oils embedded on rolling papers or blends have been used in some tobacco products in small quantities, having a minimum risk of cancer development.
4 Various products from thyme, rosemary, and chamomile, intermingled with tobacco blends and essence oils increase the flavor and make cigars more attractive.
5 No
Comments: The most important carcinogens in tobacco products are nicotine, nitrosamines, and PAHs which affect cell growth and apoptosis, expression of oncogenes, neovascularization, and treatment response.
Case 3.4
CO: A 23‐year‐old woman is referred by her physician to be evaluated for the brown patchy discoloration of her lips.
HPC: The lesions were first noticed by her mother at the age of 10, increasing in number and intensity during puberty and fading over the last three years.
MH: She suffered only from an iron deficiency anemia and bowel problems (constipation) which were initially attributed to the use of iron supplement tablets during the days of her heavy menstrual cycle, but recently, to the two small benign polyps in her small intestine. It has to be underlined that her father had a history of a colorectal carcinoma. Recent blood tests (hematological/biochemical) were within a normal range, as was her blood pressure. She was an occasional smoker and drinker, as she enjoyed mountain climbing in her free time.
OE: A thin, woman with brown lesions on the vermillion borders of her lips (lower lip mainly) (Figure 3.4), lower gingivae and buccal mucosae and on the skin around her right eye. The lesions were flat, superficial, brown discolorations with no evidence of induration or bleeding on palpation, and not associated with local lymphadenopathy or other mucosal lesions.
Q1 What is the possible cause?
1 Solar melanosis
2 Hemosiderosis
3 Cushing syndrome
4 Peutz‐Jeghers syndrome
5 Laugier‐Hunziker syndrome
Answers:
1 No
2 No
3 No
4 Peutz‐Jeghers syndrome (PJS) is the cause and characterized by numerous brown pigmented lesions on the skin, mouth, and other mucosae together with hamartomatous polyps in the gastrointestinal tract. It is an autosomal dominant genetic disease with an increased risk of developing cancer in a number of organs as found in her father with similar oral pigmentation.
5 No
Comments:
