Pathology · patient case question
The flat blue-grey macule adjacent to the amalgam restoration is best characterized as:
Patient case: White and Pigmented Oral Lesions
demo: 58-year-old male
chief: Routine examination; several mucosal findings noted.
history: Smokes one pack per day for 30 years. Occasional alcohol.
meds: None
findings: Finding 1: a small white plaque on the soft palate that does not wipe off. Finding 2: a white plaque on the lateral tongue border, 3 mm, non-wiping. Finding 3: a flat blue-grey macule in the buccal mucosa adjacent to a large amalgam restoration. Finding 4: irregular erythematous patches with white serpiginous borders on the dorsal tongue that shift location between visits. Finding 5: a bony hard midline swelling of the hard palate.
Show answer and explanation
Correct answer: A. A smooth, non-exophytic lesion consistent with amalgam tattoo
- A. Correct. An amalgam tattoo is flat, smooth, and non-exophytic, with no surface change; radiographs may show radiopaque particles. It requires no treatment when the clinical picture is typical.
- B. Ulceration with rolled borders is a malignancy pattern and is not a feature of amalgam tattoo.
- C. Exophytic growth would raise concern for melanoma or nevus and would change the management.
- D. Amalgam particles do not blanch under pressure, which helps distinguish them from vascular lesions.