Pathology · patient case with 1 question
Case: multiple pigmented macules
Scenario: Clinical photograph showing multiple small, flat, brown macules distributed over the perioral skin and vermilion.
Question 1
All of the following belong in the differential diagnosis for this presentation EXCEPT:
Show answer and explanation
Correct answer: D. Glossitis
- A. Addison disease belongs too: adrenal insufficiency raises ACTH, which drives diffuse mucocutaneous melanin deposition alongside fatigue and hypotension.
- B. Physiologic pigmentation is a legitimate consideration — symmetric melanin pigmentation, most often gingival, in darker-skinned individuals, present since childhood and entirely benign.
- C. Peutz-Jeghers syndrome fits: perioral and labial melanotic macules together with hamartomatous intestinal polyps, inherited autosomal dominant.
- D. Correct — this is the exception. Glossitis is inflammation of the tongue with erythema and papillary atrophy. It is neither pigmented nor perioral, so it does not belong in this differential.
Note: The intestinal polyps in Peutz-Jeghers are hamartomas, but these patients carry a genuinely raised lifetime risk of gastrointestinal malignancy — which is why recognising the oral signs matters.