Oral melanotic macule in a leukoderma patient: a comprehensive case report

Abstract

Introduction: Oral melanotic macules are benign pigmented lesions of the oral mucosa, characterized by increased melanin production and melanocyte activity. Unlike extraoral freckles, they are not associated with ultraviolet exposure, and their etiology remains unclear, though trauma may play a role. These lesions can occur at any age, predominantly in women (2:1), and commonly affect the lower lip, buccal mucosa, gingiva, and palate. Their similarity to malignant conditions like oral melanoma requires careful differential diagnosis.

Case report: This case report describes a 32-year-old leukoderma woman who presented with asymptomatic, well-demarcated brown macules near the palatal torus, resembling freckles. Surgical excision of the macules and removal of the torus to address potential chronic trauma were performed. Histopathological analysis confirmed melanin deposits in preserved epithelial tissue, ruling out nevus and melanoma. Postoperative care included a custom silicone splint for pain relief, analgesics, and a soft diet. The patient showed progressive healing over two years with no recurrence of the lesion.

Conclusion: This case underscores the importance of clinical expertise and histopathological evaluation in managing oral pigmented lesions. Early diagnosis is critical to prevent complications and ensure patient safety. Additionally, the report highlights trauma as a possible factor in palatal lesion development and supports the use of adjunctive therapies to enhance postoperative recovery. This contributes to the understanding and management of oral melanotic macules in clinical practice.