Kuninori Sasaoka

Amalgam tattoo of the oral mucosa mimics malignant melanoma

Figure 1. Clinical features: A blue-black macule was seen on the floor of the oral cavity adjacent to a restored tooth with dental filling. Dear Editor, Amalgam pigmentation, generally called amalgam tattoo, is a pigmented lesion on the oral mucosa. Amalgam is the most commonly used dental restorative material for dental fillings because it is inexpensive and relatively easy to manipulate during placement. Amalgam is characterized by its initial pliability and it can be easily packed to fill any irregular space. It then forms a hard, durable compound with bacteriostatic effects. Amalgam fillings are made of a mixture of several metallic particles, especially mercury, silver and tin. Clinically, amalgam tattoos appear as blue, black or dark gray asymptomatic, flat macules on the oral mucosa, located adjacent to a restored tooth, most commonly on the gingival surfaces. A pigmented mucosal lesion requires an extensive differential diagnosis, particularly with malignant melanoma. A 63-year-old woman had received treatment to her teeth many years ago. When she received dental scaling 2 months prior, an asymptomatic pigmented lesion on the oral mucosa was pointed out by a dentist. Over the next 2 months, the lesion considerably enhanced. She was referred for evaluation of an asymptomatic pigmented lesion on the oral mucosa. Physical examination revealed a 9 mm · 6 mm blueblack macule, with irregular borders on the left floor of the mouth (Fig. 1). Regional lymphadenopathy was not noted. Adjacent to the pigmented lesion, a tooth restored with a dental filling was confirmed (Fig. 1). The results of routine laboratory tests including hematology, liver and renal functions as well as C-reactive protein levels were within normal limits. X-rays did not show the presence of metallic particles in the mucosa. With the main differential diagnoses of malignant melanoma and amalgam tattoo, the lesion was completely excised.

Fibrous Dysplasia-like jaw Enlargement following Treatment with Growth Hormone

Abstract This report is of a 10-year-old boy with unusual fibrous dysplasia-like lesions in the jaw. The patient had been taking recombinant human growth hormone for the treatment of short stature due to growth hormone deficiency from the age of 8 to 10 years. The lesions were exceptionally large and affected the entire maxilla and mandible. An association with growth hormone therapy was suspected.