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JAMA Dermatology Clinicopathological Challenge
October 2017

Asymptomatic Pigmented Lesions of the Gingiva

Author Affiliations
  • 1Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia
  • 2Section of Oral and Maxillofacial Pathology, Division of Dermatopathology, Department of Dermatology, University of Pennsylvania Health System, Philadelphia
JAMA Dermatol. 2017;153(10):1045-1046. doi:10.1001/jamadermatol.2017.1614

A white woman in her 50s presented to an oral medicine clinic for evaluation of asymptomatic pigmented lesions affecting the maxillary and mandibular gingiva of 6 years’ duration. The patient reported previous orolabial melanotic macules. Her medical history was significant for hypertension, hypercholesterolemia, asthma, and breast cancer. Medications included levalbuterol, nadolol, and cetirizine. Family medical history was significant for breast cancer and social history was unremarkable. Review of systems was positive for cutaneous ephelides. Physical examination revealed a 7 mm × 6 mm asymmetric, heterogeneously pigmented lesion without indurated borders on the gingiva associated with the left maxillary central incisor tooth (number 9) (Figure, A). A lesion similar in clinical appearance, although smaller, was observed on the gingiva associated with the right mandibular first premolar tooth (number 28) (Figure, B). Biopsy specimens were obtained with a 3 mm punch instrument from both lesions for routine histology which demonstrated similar microscopic findings (Figure, C and D).