You are in: eMedicine Specialties > Dermatology > DISEASES OF THE ORAL MUCOSA Smoker's MelanosisArticle Last Updated: Feb 28, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 11
  Author: William M Carpenter, DDS, MS, Professor, Chairman, Department of Pathology and Medicine, University of the Pacific School of Dentistry William M Carpenter is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and American Academy of Oral Medicine Editors: R Stan Taylor, MD, Professor of Dermatology, University of Texas Southwestern Medical School; Director of Skin Surgery and Oncology Clinic, Department of Dermatology, University of Texas Southwestern Medical Center; Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA; Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati; Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital; William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System Author and Editor Disclosure Synonyms and related keywords: basilar melanosis, nicotine, smoking, tobacco, tobacco smoking, reverse smoking, pipe smoking, smokers, cigarette smokers, pipe smokers, reverse smokers, polycyclic compounds, melasma, hyperpigmentation, nevi, melanoma, Peutz-Jeghers syndrome INTRODUCTIONSection 2 of 11
  BackgroundThe main etiologic factor responsible for melanocytic pigmentation of the oral mucosa in the white population is cigarette smoking. In his 1977 report, Hedin1 coined the term smoker's melanosis to describe this clinical condition. PathophysiologySmoker's melanosis may be due to the effects of nicotine (a polycyclic compound) on melanocytes located along the basal cells of the lining epithelium of the oral mucosa. Nicotine appears to directly stimulate melanocytes to produce more melanosomes, which results in increased deposition of melanin pigment as basilar melanosis with varying amounts of melanin incontinence. FrequencyUnited StatesNo prevalence studies are available in the United States. InternationalIn a Swedish study of 31,000 whites, 21.5% of tobacco smokers exhibited this lesion, whereas only 3% of nonsmokers had the lesion.2 In a study of Thai subjects and Malaysian subjects, nearly all had physiologic pigmentation, but tobacco users had significantly more oral surfaces displaying pigmentation.3 Mortality/MorbiditySmoker's melanosis is not associated with mortality or morbidity. RaceThis condition is most evident in whites because of a lack of physiologic pigmentation in the oral mucosa of this population, but some dark-skinned individuals who smoke will have more prominent pigmentation in many oral sites. SexFemales are affected more than males, which may be explained by the additive effects of estrogen in female smokers. Increases in estrogen levels observed during pregnancy and the use of birth control pills are linked to other hyperpigmentation conditions (eg, melasma). AgeThe incidence of smoker's melanosis increases with age, suggesting that the longer a person smokes, the more likely he or she will develop the condition.4 CLINICALSection 3 of 11
HistoryNo symptoms are associated with this condition. A smoking history is needed to substantiate the diagnosis. PhysicalSmoker's melanosis is a brownish discoloration of the oral mucosa. In cigarette smokers, most lesions are located on the mandibular anterior gingiva. Pipe smokers more frequently display pigmentation of the buccal mucosa. In people who engage in reverse smoking (ie, the lit end of a cigarette placed in the oral cavity), pigmentation of the hard palate is common. If the areas become depigmented and erythematous, squamous cell carcinoma has been found in 12% of these patients.5 See Media File 3. CausesThis condition is likely due to direct effects of tobacco smoke on the oral mucosa. Smoke is thought to cause changes in the mucosa through a combination of physical (heat) and/or chemical (nicotine) effects. Individuals using smokeless tobacco or nicotine-containing gum do not develop this condition. DIFFERENTIALSSection 4 of 11
Addison Disease Albright Syndrome Hemochromatosis Neurofibromatosis Oral Malignant Melanoma Oral Nevi
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| Media file 1: Several focal brownish pigmentations of the maxillary anterior gingiva. | |
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| Media file 2: Gingival biopsy of a basilar melanosis (a brownish granular pigment present along the basal cells). | |
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| Media file 3: A reverse smoker with white and pigmented palatal mucosa and a focal area of erythema. | |
 | View Full Size Image | Media type: CT |
Article Last Updated: Feb 28, 2007
