An unusual clinical presentation of gingival melanoacanthoma
A 13-year-old male patient attended the Department of Periodontics, Mahatma Gandhi Post Graduate Institute of Dental Sciences, Pondicherry, in May 2011 for gingival enlargement and difficulty in mastication. The patient was otherwise healthy. He first noticed enlargement 6 months earlier along the buccal aspect of tooth 26, which increased in size slowly to the present clinical picture. The clinical examination was significant for the presence of pigmented diffuse gingival enlargement along buccal and palatal aspects of 24, 25, 26, 27 and lingual aspects of teeth 34, 35, 36, 37 []. Gingival enlargement was extending up to middle third of the crown of tooth 24, partially covering the occlusal surface of teeth 25, 26 and completely covering the tooth 27 [] and extending up to occlusal surface of teeth 34, 35, 36, 37. The gingival enlargement was firm in consistency, painless, brownish black in color with well-defined borders and there was no associated erythematous background.\nOther significant dental findings included root canal treated fractured tooth 21 and congenitally missing tooth 23. Patient's oral hygiene was deemed satisfactory. There was no significant medical history. Patient was not having any associated cutaneous pigmentary changes. Based on the clinical findings, provisional diagnosis of idiopathic gingival enlargement was made and gingivectomy was planned for the treatment.\nPatients’ parents provided oral consent for treatment prior to the initial and additional tests and the dental treatment that followed. Routine blood investigations were found to be within normal limits. Gingivectomy was performed under local anesthesia on the buccal aspect of II quadrant [] and the excised tissue was sent for biopsy []. One week later, gingivectomy was performed on the palatal aspect of II quadrant followed by lingual aspect of III quadrant after 1 week. Kirkland knives were used for incisions on the facial and lingual surfaces. Orban periodontal knives were used for interdental incisions. Patient experienced an uneventful post-operative recovery [] at 1 year recall examination there was no recurrence of gingival enlargement at the surgical sites []. Patient will continue to be monitored on a 6 month basis and any new gingival enlargement/lesion will undergo histopathologic investigation.\nHistopathological examination revealed numerous dendritic melanocytes distributed in basal and suprabasal layers of acanthotic epithelium. Melanocytes did not display any cytologic atypia []. The connective tissue was normal except for the presence of occasional eosinophils. There was no spillage of melanin pigment/melanocytes in subepithelial zone []. Histopathologic diagnosis of oral melanoacanthoma was rendered.