Correct answer: (b) Amalgam Tattoo
The list above is the appropriate differential for a localized pigmented lesion in the oral cavity. The first step after recognizing the lesion is to take a radiograph. If small radiopaque “flecks” (as noted in the radiograph above) are noted, this is sufficient for the diagnosis of an amalgam tattoo and no further treatment is necessary. The lack of radiographic evidence of a foreign material (amalgam) would support the recommendation for a biopsy to confirm the diagnosis and rule out melanoma. An amalgam tattoo is due to the implantation of dental amalgam into oral soft or hard tissue. Clinically, the lesions are black, blue or grey in soft tissue tattoos. A blue nevus is most commonly on the hard palatal mucosa and is a
melanocytic tumor that usually exhibits slight surface elevation. They are typically less than 1 cm in diameter. An oral melanotic macule is a brown asymptomatic macule produced by focal increases in melanin deposition and are not dependent on sun exposure. The most common site is the vermilion zone of the lower lip (labial melanotic macule). Over 80% are solitary lesions that are less than 7mm is diameter and tend to be well demarcated. There is no malignant transformation potential but these lesions cannot be distinguished clinically from early melanoma. Mucosal melanoma presents at an advanced state and is more aggressive than skin melanomas, making an early diagnosis critical. To distinguish between melanoma and other pigmented lesions (like the benign melanocytic nevus), the ABCDE system has been developed to describe the clinical features of melanoma: A- Asymmetry B- Border irregularity C- Color variation D- Diameter is greater than 6mm (but they can be smaller) E- Evolving lesions (sudden increase in size) Works Cited Neville, Damm, Allen, Chi (2016). Oral and Maxillofacial Pathology, 4th Ed. St. Louis: Elsevier.
Bryan Trump, D.D.S, M.S. Associate Professor Oral & Maxillofacial Pathology University of Utah School of Dentistry
ASSOCIATION LOOKING FOR A FEW GOOD DENTISTS As part of the responsibilities of the State Board of Dental and Hygiene Licensure, includes the opportunity to help fellow professionals. From time to time, one of your colleagues has a challenge come into their life that compromises their dental licensure. When this occurs, the Utah State Dental Advisory Board (DOPL Board) works to help them regain their opportunity to bring their licensure back to a full privilege level. As part of this process, they need another dentist to supervise/ mentor them on their road to recovery. The DOPL Board is looking for Dentists in every part of the state (but mostly along the Wasatch Front) who would be available and interested in assisting a colleague in this journey. A supervisor’s responsibilities (many of which can be done online/remotely) are these: meet weekly with your assigned colleague, provide oversight of clinical services/patient treatment, their sobriety, boundaries, ethics, and professional relationships. They would also review monthly 20% of their assigned 12
colleague’s current patient charts (these charts to be chosen randomly by the supervisor). A supervisor would also make regular monthly or quarterly reports to the DOPL board regarding the progress of their supervisee. They would also review their colleague’s prescriptions and drug administration log weekly or monthly. Again, many of these responsibilities can be done online (remotely) so as to take a minimal amount of your time. The DOPL staff will also greatly assist throughout the process. If you would like to know more about this opportunity to serve your profession as well as your community at large, please contact the UDA office. Your help in this process would be invaluable to a fellow dentist, the State Dental Advisory Board, and your community. Please give the UDA a call at 801-261-5315 or email the UDA office at UDA@uda.org or dotty@uda.org . Dr Dan Poulson State Board of Dental and Hygiene Licensure (DOPL Board) July / August 2021
