Description, Causes and Risk Factors:
Smoker's melanosis is a benign pigmentation of the oral mucosa, predominantly observed on the attached anterior mandibular gingiva and interdental papillae. These macular lesions are independent of genetic factors, therapeutic medication usage, and various systemic disorders. As a group they are often seen after the third decade of life. Due to the onset in adulthood and the progressive darkening, malignant melanoma must be ruled out.
Smoking may cause oral pigmentation in light-skinned individuals and accentuate the pigmentation of dark-skinned patients. There is increased production of melanin, which may provide a biologic defence against the noxious agents present in tobacco smoke. Smoker's melanosis occurs in up to 21.5% of smokers. The intensity of the pigmentation is related to the duration and amount of smoking.
Smoker's melanosis is also likely due to direct effects of tobacco smoke on the oral mucosa. Smoke is thought to cause changes in the mucosa through a combination of physical (heat) and/or chemical (nicotine) effects. Individuals using smokeless tobacco or nicotine-containing gum do not develop this condition.
Smoker's melanosis may be also due to the effects of nicotine on melanocytes located along the basal cells 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.
A study in Sweden showed that 21.5% of smokers and 3% of nonsmokers had lesions that could be classified as smoker's melanosis.
Smoker's melanosis is most evident in whites because of a lack of physiologic pigmentation in the oral mucosa of this population, but some dark-skinned individuals who smoke will have more prominent pigmentation in many oral sites.
Females are affected by smoker's melanosis more than males, which may be explained by the additive effects of estrogen in female smokers. Increases in estrogen levels observed during pregnancy and the use of birth control pills are linked to other hyperpigmentation conditions.
There may be 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 (i.e., the lit end of a cigarette placed in the oral cavity), pigmentation of the hard palate is common. If the areas become depigmented and erythematous, squamous cell carcinoma has been found in 12% of these patients.
Generally, no laboratory studies are necessary to confirm the diagnosis of smoker's melanosis; clinical impression is usually sufficient, in combination with a history of smoking. If the pigmentation is localized, an ulceration is present or the lesion is elevated, a biopsy is necessary to exclude other pigmented conditions (eg, nevi, melanoma). Although smoker's melanosis is an abnormal deposition of melanin, the lesion itself is not associated with an increased risk of melanoma or carcinoma.
Smoker's melanosis usually disappears within 3 years of smoking cessation. Biopsy should be performed if there is surface elevation or increased pigment intensity or if the pigmentation is in an unexpected site. Routine follow-up care is necessary to ensure that the lesion is slowly disappearing.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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