Etiology • Melanin pigmentation of oral mucosa in heavy smokers • May occur in up to 1 of 5 smokers, especially females taking birth control pills or hormone replacement • Melanocytes stimulated by a component in tobacco smoke
Clinical Presentation • Brownish discoloration of alveolar and attached labial gingiva,
buccal mucosa • Pigmentation is diffuse and uniformly distributed; symmetric
gingival pigmentation occurs most often. • Degree of pigmentation is positively influenced by female
hormones (birth control pills, hormone replacement therapy). Microscopic Findings
• Increased melanin in basal cell layer • Increased melanin production by normal numbers of
melanocytes • Melanin incontinence
Diagnosis • History of chronic, heavy smoking • Biopsy • Clinical appearance
Differential Diagnosis • Physiologic pigmentation • Addison’s disease • Medication-related pigmentation (drug-induced pigmentation by
chloroquine, clofazimine, mepacrine, chlorpromazine, quinidine, or zidovudine)
• Malignant melanoma Treatment
• None • Reversible, if smoking is discontinued
Prognosis • Good, with smoking cessation