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. 2025 Jun 1;59(2):143-149.
eCollection 2025 Jun.

A simultaneous presentation of uncommon, pigmented lesions: Oral melanoacanthoma and moderate oral epithelial dysplasia

Carlo Sgarbanti  1 , Carla Penner  2 , Vimi S Mutalik  1
Affiliations

A simultaneous presentation of uncommon, pigmented lesions: Oral melanoacanthoma and moderate oral epithelial dysplasia

Carlo Sgarbanti et al. Can J Dent Hyg. .

Abstract
in English, French

Introduction: Melanin-containing mucosal lesions can present a diagnostic challenge due to the presence of a wide range of lesions with a similar clinical appearance.

Case description: This is a report of a unique case of the simultaneous presentation of 2 pigmented lesions in a 68-year-old white female patient.

Discussion: The first pigmented lesion on the ventral tongue was diagnosed as melanoacanthoma, which does not have any potential for malignant transformation. The ventral tongue is a very unusual location for a melanoacanthoma. Interestingly, another lesion on the buccal mucosa with a similar appearance presented as moderate epithelial dysplasia with increased melanin pigment that has the potential for malignant transformation. Pigmented moderate oral epithelial dysplasia is a very rare condition. The simultaneous presence of a melanoacanthoma would have led to a mistaken assumption of multifocal melanoacanthoma which, although rare, has been described in the literature.

Conclusion: These findings reinforce that it is prudent to perform multiple biopsies of all suspicious oral lesions.

Introduction : Les lésions muqueuses contenant de la mélanine peuvent présenter un défi diagnostique en raison de la présence d’un large éventail de lésions ayant un aspect clinique similaire.

Description du cas : Le présent rapport fait état d’un cas unique de la présentation simultanée de 2 lésions pigmentées chez une patiente blanche âgée de 68 ans.

Discussion : Le diagnostic de la première lésion pigmentée sur la langue ventrale est celui d’un mélanoacanthome, qui n’a pas de potentiel de transformation maligne. Il est très rare qu’un mélanoacanthome se trouve sur la partie ventrale de la langue. Fait intéressant, une autre lésion de la muqueuse buccale d’apparence similaire s’est révélée être une dysplasie épithéliale modérée avec une augmentation du pigment mélanique qui présente un potentiel de transformation maligne. La dysplasie épithéliale buccale modérée pigmentée est une affection très rare. La présence simultanée d’un mélanoacanthome aurait mené à l’hypothèse erronée d’un mélanoacanthome multifocal qui, bien que rare, a été décrit dans la documentation.

Conclusion : Ces résultats confirment qu’il est prudent d’effectuer des biopsies multiples de toutes les lésions buccales suspectes.

Keywords: mouth; oral; oral melanoacanthoma; pigmented lesions; pigmented moderate oral epithelial dysplasia.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Pigmented macule on the left lateral tongue (Lesion 1)
Figure 2.
Figure 2.
Pigmented macule on the left buccal mucosa (Lesion 2)
Figure 3.
Figure 3.
Ventral tongue lesion (Lesion 1). Low-power view showing hyperplastic surface epithelium without significant atypia (H and E, 10× magnification)
Figure 4.
Figure 4.
Ventral tongue lesion (Lesion 1). Mild acanthosis with presence of melanocytes at all levels of the epithelium (H and E, 20× magnification)
Figure 5.
Figure 5.
Ventral tongue lesion (Lesion 1). High-power view showing the radiating dendritic processes of the melanocytes (H and E, 40× magnification)
Figure 6.
Figure 6.
Two-week follow-up of the lesion on the ventral tongue (Lesion 1)
Figure 7.
Figure 7.
One-year follow-up of the pigmented macule on the left buccal mucosa (Lesion 2)
Figure 8.
Figure 8.
Buccal mucosa lesion (Lesion 2). Low-power view showing the architectural and cytological features of dysplasia extending to the middle third of the epithelium (H and E, 10× magnification)
Figure 9.
Figure 9.
Buccal mucosa lesion (Lesion 2) showing abnormal maturation pattern in the epithelium interspersed with melanin pigmentation and melanin incontinence (H and E, 20× magnification)
Figure 10.
Figure 10.
One-month follow-up of the lesion on the left buccal mucosa (Lesion 2)
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