A Guide to Clinical Differential Diagnosis of Oral Mucosal Lesions

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


Tattoo* is a localized pigmented area caused by implantation of foreign material into skin or oral mucosa. Oral tattoos are usually caused by amalgam particles or graphite in lead pencils. A tattoo is localized, dark gray to black, non-tender, and either macular or slightly thickened. A tattoo sometimes increases in size due to ingestion of the foreign material by phagocytes and then migration of these cells. Some tattoos can be visualized on a radiograph, but absence of radiographic evidence of amalgam particles does not exclude the diagnosis of tattoo. Obviously, some tattoos are intentional artistic endeavors and do not cause a diagnostic challenge.

The typical small, localized, non-thickened tattoo does not require treatment, once a diagnosis is made. A tattoo that is thickened and does not have amalgam particles evident on a radiograph should be biopsied so that nevus and melanoma can be excluded.

Image: Tattoo
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