Authors: DR.M.VEERESH (ASSOCIATE PROFESSOR), DR.H.NANDAKUMAR (PROF AND HOD), DR.HARSHITHA (P.G STUDENT), DEPT. OF ORAL AND MAXILLOFACIAL SURGERY, KRISHNADEVARAYA COLLEGE OF DENTAL SCIENCES

ABSTRACT
Intraoral pigmentation is quite common and has numerous etiologies, ranging from exogenous to physiological to neoplastic. Many pigmented lesions of the oral cavity are associated with melanin pigment. In this case report we are presenting smoker’s melanosis of the buccal mucosa. The etiology, clinical and histological features treatment plan were discussed with review.

KEY WORDS
Melanin, pigmentation, smoker’s melanosis, buccal mucosa.

INTRODUCTION

Oral pigmentations are increased significantly in heavy smokers. Melanin pigmentation in the skin exerts a well known protective effect against ultraviolet damage. Investigations of melanocytes located away from sun exposed areas have shown the ability of melanin to bind to noxious substances. Exposure to polycylic amines such as nicotine and benzpyrenes has been shown to stimulate melanin production by melanocytes that are known to bind strongly to nicotine. It has been suggested that melanin production in the oral mucosa of smokers serves as a protective response against some harmful substances in tobacco smoke.1. Here we are reporting case of smoker’s melanosis of right buccal mucosa. The incidence, etiology, clinical features, differential diagnosis and treatment were discussed.

CASE REPORT
Thorough clinical examination revealed brownish black discoloration in the right buccal mucosa measuring 2x2 cm with no ulceration(fig 1).
A 28 year old male patient reported to our hospital with the complaint of non healing patch on the right side of buccal mucosa since one and half year. Personal history reveals of smoking cigarette since 7 to 8 years. Thorough clinical examination revealed brownish black discoloration in the right buccal mucosa measuring 2x2 cm with no ulceration(fig 1). Lymph nodes were not palpable. An excisional biopsy done(fig 3-4), which suggests of smoker’s melanosis of buccal mucosa and shows following histological features. Sections show para to ortho keratotic stratified squmaous epithelium with prominent granular layer. The asal layer shows increased melanin pigmentation with bulbous rete ridges. Underlying connective tissue stroma is dense and collagenous with mild chronic inflammatory infiltrate(fig.2). Patient has been put under antibiotics and analgesics for 5 days. Follow up done for a period of one year and there was no sign of recurrence.







DISCUSSION

Smoker’s melanosis is a brownish discoloration of the oral mucosa. In cigarette smokers, most lesions are located on the mandibular anterior gingiva. Pipe smokers more frequently display pigmentation of the buccal mucosa. In people who engage in reverse smoking (the lit end of a cigarette placed in the oral cavity), pigmentation of hard palate is common.2. The incidence of smoker’s melanosis increases with the age, suggesting that longer a person smokes, the more likely he will develop the condition. Smoker’s melanosis may be due to the effects of nicotine (a polycyclic compound)on melanocytes located along the basal cell of the lining epithelium of the oral mucosa. Nicotine appears to directly stimulate melanocytes to produce more melanosomes, which results in increased deposition of melanin pigment as basilar melanosis with varying amounts of melanin incontinence. Some studies said that females are affected more than males, which may be explained by the additive effects of estrogen in female smokers. Increase in estrogen levels observed during pregnancy and the use of birth control pills are linked to other hyperpigmentation condition.2. The differential diagnosis of mucosal pigmented lesions include, hematomas, varices, and petechiae which may appear to be pigmented.3. Anders Hedin conducted study to evaluate frequency and extension of melanin pigmentation in the attached gingiva and its relation to tobacco smoking. He concluded that smoker’s melanosis is considered to be caused by tobacco smoking and is expected to be found in other parts of oral mucosa.4. The lesion usually disappears if the patient stops smoking. If it does not disappear, however, a biopsy can be used to verify the diagnosis.smoker’s melanosis is a benign and does not develop into cancer.5.

CONCLUSION

Smoking is the cause for the smoker’s melanosis. Histological features and history of smoking in the form of cigarette or tobacco is needed to substantiate the diagnosis. It is benign in nature and does not develop into malignancy. Smoker’s melanosis is not associated with morbidity and mortality.

REFERENCES

1. Noville, Dam, Allen, Boquet; Text book of oral and maxillofacial pathology. 274-5
2. William.M.Carpenter; Smoker’s melanosis, emedicine>dermatology>diseases of oral mucosa. 6: 2009.
3. Susan Muller; Melanin-associated pigmented lesions of the oral mucosa; presentation,differential diagnosis and treatment. Dermatologic therapy. 23:220-9.
4. C.Anders Hedin; Smoker’s melanosis: occurrence and localisation in the attached gingival. Arch Dermatol. 113: 1533-8