The diagnosis is clinical.<unk>  can be distinguished from other causes of localized oral pigmentation because it does not change significantly in size or color, although it may appear to slowly enlarge for several months after the initial implantation of the metal particles. Some<unk> s appear radio-opaque on radiographs (i.e. they show up on x-rays), although in many cases,<unk> s have no radiographic features since the responsible particle(s) of<unk>  are very small even though clinically the area of discolored mucosa is much larger. If necessary, the diagnosis can be confirmed histologically by excisional biopsy, which excludes nevi and melanomas. If a biopsy is taken, the histopathologic appearance is: * Pigmented fragments of metal within connective tissue * Staining of reticulin fibers with silver salts * A scattered arrangement of large, dark, solid fragments or a fine, black or dark brown granules * Large particles may be surrounded by chronically inflamed fibrous tissue * Smaller particles surrounded by more significant inflammation, which may be granulomatous or a mixture of lymphocytes and plasma cells
Amalgam tattoo
Soot tattoo
Debulking
Circumcision
Cigarette burns
Tincture of benzoin
Scorpion sting
Indoor tanning