Smokers Melanosis

Heavy smokers can sometimes develop areas of oral hyperpigmentation. It is more common in women than men. Although any part of the mouth can be affected the anterior gingivae are involved most frequently. The lesions vary in colour from light brown to bluish-black and the lesions may be focal or diffuse. Sometimes the overlying mucosa has a somewhat milky-white appearance, particularly in the buccal mucosa. The condition can slowly resolve if smoking is stopped or reduced [72]. Pigmentation of the soft palate has been reported in a significant number of patients with suppurative lung disease and malignancy [117]. Nearly a quarter of patients with confirmed bronchogenic carcinoma show this feature. Most patients have a long history of cigarette smoking and it is possible that in many cases these lesions were merely smoker's melanosis rather than being related directly to the pulmonary lesions.

Microscopy may show slightly increased melanot-ic pigmentation of the basal keratinocytes, but the most striking feature is usually pigmentary incontinence and accumulation of melanophages in the superficial cori-um.

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