Racial pigmentation<unk>  affects about 3% of the population and is most likely seen in those with dark skin; however people with light skin have, on average, 30 local pigmented areas and in some circumstances will present intra-orally. They are more often found in females than males and the typical age at presentation is 40 years although they can appear at any age. Black hairy tongue Black hairy tongue is a harmless condition which causes blackening pigmentation on the dorsum of the tongue. It is a very common<unk>  condition and affects 13% of the world population. It is often due to poor<unk>  hygiene which leads to accumulation of<unk>  bacteria and build up of keratin on the tongue surface. Black hairy tongue can also be associated with the use of certain medications such as antibiotics, prolonged coffee/tea drinking habit, or smoking. Amalgam tattoo The amalgam tattoo is mostly found on the alveolar or gingival mucosa (however can sometimes found on the buccal mucosa) and is more commonly found in females and older patients. It appears as painless, blue/gray/black, nonulcerated, soft macule without any erythematous reaction surrounding it. The tattoos greatest diameter is usually less than 0.5 cm and some lesions containing larger particles may be identifiable on certain radiographs. Some patients exhibit a long-term inflammatory response and if so they may produce discoloured, small papules. The discoloured patch may enlarge over time in patients demonstrating a strong macrophage response Amalgam deposits can be found within bone occasionally. This can be caused during a surgical procedure eg tooth extraction or endodontic surgery, which has caused the material to become inadvertently dislodged from a restoration in an adjacent tooth. These deposits become blackened and can lead to blackening of the adjacent bone. Peutz–Jeghers syndrome The autosomal dominant disorder Peutz–Jeghers syndrome is characterized by ‘intestinal hamartomatous polyps in association with mucocutaneous melanocytic macules’. These macules often vary in shades of brown, size and are confluent, Although any<unk>  site can be affected, in almost all cases pigmented macules appear on the buccal mucosae, lips and around the mouth. Pigmented macules on the face are less common. The extent of<unk>  involvement and degree of pigmentation varies between each individual case. An individual who has this syndrome has a relative risk fifteen times greater of developing cancer in comparison to the general population. In older patients, the main consequence of the syndrome is cancer. The sites mainly affected include the pancreas, stomach, lungs, colon, small intestine, uterus, breasts and the ovaries and breasts. Additionally, Peutz-Jeghers Syndrome can be associated with other reproductive site cancers including sertoli cell tumours and adenoma malignum of the cervix. In young patients, intussusception and obstruction of the small intestinal obstruction and are the main complications, these are caused by the small intestinal location of the polyps. Addison's disease Addison’s disease can be caused by a variety of pathological processes. It is an endocrinal disorder where there is an increased amount of adrenocorticotropic hormone (ACTH) as a result of deficient amounts of hormones being produced from the adrenal cortex. Due to this, dark pigmentation may be visible on the<unk>  mucosa or skin. Most common<unk>  sites include: buccal mucosa, lips, gums, hard palate or tongue. Intraoral sites are usually seen as the first sign and they usually develop prior to the skin lesions. In developing countries, this disease is often associated with tuberculosis, where the infection can lead to destruction of the adrenal gland. Systemically<unk>  melanosis can also be associated with the following; *Pregnancy *Oral contraceptive intake *Exposure to sunlight *HIV *Antimalarial drug therapy Kaposi's sarcoma This is an intermediate neoplasm which affects the skin and mucous membranes; usually arising in patients with HIV. The stages of this type of pigmentation start from an early patch stage, to become plaque-like which then develop into larger nodules- known as the tumour stage. It is common to have<unk>  involvement with this disease and frequently this is associated with a poor prognosis. Smoker's melanosis Smoker’s Melanosis, benign melanocytic pigmentation of the<unk>  mucosa, most commonly seen in the lower labial gingiva and interdental papillae of smokers. Smoking results in an increase of melanin deposit in the<unk>  mucosa through physical thermal damage and chemical interaction between melanin and nicotine compounds, but this is not the only risk factor towards the pigmentation, it is also associated with other aetiology factors.<unk>  melanoacanthoma<unk>  melanoacanthoma are benign pigmented lesions due to dendritic melanocyte proliferation and superficial epithelium acanthosis. Clinically characterized by a rapidly growing macular brown lesion that appears suddenly. Melanocytic nevi<unk>  nevi or<unk>  melanocytic nevi, are result of benign proliferations of nevus cells present either in the epithelial layer, the submucosal layer or both. Most commonly seen presentation of<unk>  nevi are intramucosal nevi, these are dome shaped brown papules accounting for 64% of all reported case of<unk>  nevi. Other presentation of<unk>  nevi includes: Blue nevus, junctional nevus and compound nevus. Melanotic macules Melanotic macules can be found on the buccal mucosa, lip, palate, alveolar ridge and gingiva. Melanotic macules are benign pigmented lesions that are found in the<unk>  cavity, caused by an increase in pigmentation in the basal cell layer of the epithelium and the lamina propria. Clinically presentation of melanotic macules are typically a brown, black, blue or grey area that is well circumscribed, lesions are usually less than 10 mm in diameter but can be larger in some cases. Vermillion border of the lips is the most common site to find melanotic macules.<unk>  melanoma This type of<unk>  malignancy is very rare. It’s caused by proliferation of malignant melanocytes within the connective tissues. Most common<unk>  sites include the hard palate and gums. The presentation of<unk>  melanoma can vary; some could be asymptomatic pigmented areas, whilst others could be rapidly growing areas of ulceration with symptoms such as, bone destruction, pain and bleeding. To stage<unk>  melanoma, the TNM clinical staging system is used. This stands for ‘Tumor – Nodes – Metastasis’. It highlights the three stages: stage I is a primary tumor; stage II is a metastatic tumor which has spread to regional lymph nodes and; stage III is a metastatic tumor which has spread to distant sites.
Oral pigmentation
Nipple pigmentation
Breast hypertrophy
Hypopigmentation
Trichomegaly
Blue nails
Tooth discoloration
Green nails