A clinician observes pigmented areas on the gingiva of a healthy child with otherwise normal tissues. What is the most likely explanation?

Symmetric, asymptomatic gingival pigmentation in a healthy child is most often physiologic (racial) melanin pigmentation, a normal variant.Other options: Amalgam tattoo relates to restorations; melanoma is rare and asymmetric/changing; Addison disease causes diffuse pigmentation with systemic signs.Key exam takeaway: Diffuse, symmetric gingival pigment in a healthy child = physiologic melanin pigmentation.