A panoramic radiograph and a focal bluish-gray gingival discoloration in an area of prior amalgam restoration most likely represent:

Correct answer: A. Amalgam tattoo

• A. Correct. Amalgam particles embedded in soft tissue create a flat blue-gray macule (amalgam tattoo); radiopaque flecks may be visible.
• B. Melanoma would be a concerning pigmented lesion, but the history of adjacent amalgam strongly favors tattoo.
• C. A nevus is a benign melanocytic lesion without an amalgam source.
• D. A hemangioma blanches on pressure and is vascular, not metallic pigment.