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A Guide to Clinical Differential Diagnosis of Oral Mucosal Lesions
Table 2. Localized Pigmented Surface Lesions of Oral Mucosa

Course Author(s): Michael W. Finkelstein, DDS, MS; Emily Lanzel, DDS, MS; John W. Hellstein, DDS, MS

Table 2. Localized Pigmented Surface Lesions of Oral Mucosa

INTRAVASCULAR BLOOD LESIONS
Usually blanch on pressure and compressible
Varix Blue; thickened; sometimes does not blanch due to thrombosis.
Hemangioma Congenital; thickened; red or blue
Kaposi sarcoma Patient is immunocompromised; may be thickened or flat.
EXTRAVASCULAR BLOOD LESIONS
Do not blanch; present for less than 1 month; may have history of injury or bleeding problem.
Hematoma Thickened; firm to palpation.
Ecchymosis Not thickened
Petechiae Focal and pinpoint size; red; multiple; not thickened
MELANOCYTIC LESIONS
Persistent; do not blanch
Ephelis (freckle) Not thickened; located on sun-exposed surfaces.
Oral melanotic macule Not thickened; located on mucosa not exposed to sun
Nevus Thickened; may be flat early in development
Melanoma Thickened; may be flat early in development
TATTOO
Do not blanch; may be history of injury; radiopaque object sometimes seen on radiograph; may be thickened or flat.
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