Deck 5: Pigmented Lesions

Question 1

A 30-year-old woman presents with recently acquired generalized tanning of the skin and multiple intraoral pigmented macules. Oral biopsy showed excessive melanin pigment in basal keratinocytes. This patient should be suspected of having:

A) Addison's disease
B) Sunburn
C) Kaposi's sarcoma
D) Leukemia
E) Melanoma

Answer 1

Addison's disease

Question 2

All of the following are known to have the capacity to cause oral mucosal pigmentation except:

A) Amalgam
B) Bismuth
C) Mercury vapors
D) Penicillin
E) Minocycline

Answer 2

Penicillin

Question 3

Mucosal neuromas, pheochromocytoma, and medullary carcinoma of the thyroid constitute which of the following syndromes?

A) Albright's syndrome
B) Sjögren's syndrome
C) von Recklinghausen's disease of skin
D) Peutz-Jeghers syndrome
E) None of the above

Answer 3

None of the above

Question 4

Oral mucosal lesions may exhibit a red to blue to black color for one of several reasons. These would include all the following except:

A) Increased number of submucosal vessels
B) Submucosal extravasation of blood
C) Deposition of foreign material
D) Increased thickness of epithelium
E) Hyperemia (vascular congestion)

Question 5

All the following drugs are known to have the ability to cause pigmentation of the oral mucosa except:

A) Dilantin
B) Minocycline
C) Cytoxan
D) AZT (zidovudine)

Question 6

A 37-year-old man presents with a blue-black macule (1 * 1 cm) in his palate. The area is covered with intact epithelium and there was no apparent inflammatory response. Biopsy shows deposits of black foreign material. This suggests which of the following?

A) Kaposi's sarcoma
B) Melanoma
C) Amalgam tattoo
D) Erythroplakia
E) Melanotic macule

Question 7

Café-au-lait macules (more than five) and multiple neurofibromas are typically seen in which of the following conditions?

A) Lichen planus
B) Crohn's disease
C) Addison's disease
D) Peutz-Jeghers syndrome
E) None of the above

Question 8

Both in situ and invasive oral melanomas exhibit the same distinctive site predilection. This is the:

A) Buccal mucosa
B) Palate
C) Lateral tongue
D) Lower lip
E) Tonsillar pillar

Question 9

Which of the following pigmented lesions of oral mucosa is most commonly encountered in dental patients?

A) Freckles (ephelides)
B) Intramucosal nevus
C) Melanoma
D) Amalgam tattoo
E) Bismuth line

Question 10

The characteristic oral manifestation of Peutz-Jeghers syndrome is:

A) Bilateral reticular white lesions in the buccal mucosa
B) Red patch in the palate
C) Nodular yellow-white lesions in the buccal mucosa
D) Perioral pigmented macules
E) Red patch on midline dorsum of the tongue

Question 11

Lateral or radial spread at the epithelial-connective tissue interface is a characteristic growth feature of which of the following pigmented lesions?

A) Blue nevus
B) Ephelis
C) In situ melanoma
D) Invasive melanoma
E) Amalgam tattoo

Question 12

All the following suggest the possibility of intraoral melanoma except:

A) Rapid increase in size
B) Satellite lesions
C) Ulceration
D) Bilateral symmetric lesions
E) Darkening color

Question 13

Pigmented nevi are commonly seen in skin but are relatively rare in the oral mucosa. Intraorally, they are most likely to be found in which of the following locations?

A) Tongue
B) Buccal mucosa
C) Floor of mouth
D) Lower lip
E) Palate

Question 14

In addition to multiple neurofibromas, what other lesions are seen as part of the syndrome neurofibromatosis?

A) Traumatic neuromas
B) Mucosal vascular malformations
C) Intestinal polyps
D) Cutaneous pigmented patches
E) Odontogenic keratocysts

Question 15

A 34-year-old man presents with an asymptomatic 1 * 1 cm pigmented lesion in the right side of his palate. It is flat, and it is asymptomatic. Biopsy shows melanin pigment within a collection of benign-appearing spindle-shaped cells in the submucosa. This is consistent with:

A) Melanoma
B) Amalgam tattoo
C) Blue nevus
D) Melanotic macule
E) Physiologic pigmentation

Question 16

Generally, which of the following has the worst prognosis?

A) Oral verrucous carcinoma
B) Cutaneous basal cell carcinoma
C) Cutaneous melanoma
D) Oral melanoma
E) Oral erythroplasia

Question 17

Amalgam tattoo is a common oral lesion that must be differentiated through clinical history or biopsy from which of the following?

A) Chronic infection
B) Squamous cell carcinoma
C) Early melanoma
D) Hereditary hemorrhagic telangiectasia
E) Gardner's syndrome

Question 18

Oral melanomas are classified into microscopic subtypes based primarily on which of the following feature?

A) Evidence of invasion of lymphatic vascular spaces
B) Microscopic growth pattern
C) Number of mitotic figures
D) Nuclear pleomorphism
E) Evidence of lymph node metastasis

Question 19

A 40-year-old woman presents with multiple melanotic macules of her lips and buccal mucosa. If the patient is found to have adrenal insufficiency, which of the following conditions should be considered?

A) von Recklinghausen's disease of skin
B) McCune-Albright syndrome
C) Addison's disease
D) Peutz-Jeghers syndrome
E) None of the above

Question 20

Which of the following can have clinical features that are similar to early superficial or in situ melanoma?

A) Early Kaposi's sarcoma
B) Amalgam tattoo
C) Drug-induced pigmentation
D) Melanotic macule
E) All of the above