Palatal Blue Nevus In Children 7/24/09

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Murphy Date:7/24/09 Region: Prov.
Article title: Palatal Blue Nevus In Children
Author(s): Flaitz, Catherine, DDS
Journal: Pediatric Dentistry
Volume #; Number; Page #s): 23:4, 2
Year: 2001
Major topic: Palatal Blue Nevus
Minor topic(s): Other soft tissue pigmentations
Type of Article: Case Report
Main Purpose: Review a case of blue nevus(BN) in a child
Overview of method of research: N/A

Findings: Except for vascular entities, blue lesions are relatively uncommon in a child’s oral cavity. They are mostly found on the skin. In this case, a 7 yo female presented with an asymptomatic, non-blanching, smooth, bright blue oval macule measuring 7mm x 4mm on her palate. There was no history of trauma. Treatment was excisional biopsy. Histologically, there was heavily pigmented spindle shaped cells with dendritic extensions aligned parallel to the epithelium.

Key points in the article discussion: Oral nevi are farely rare, with a prevalence of .1% in the general population. The BN is the second most common type of nevi, accounting for 36% of all nevi found. BN present as a solitary blue-gray macule that’s slightly raised, less than 6mm in size, regular margins, and a smooth surface. The most common site for a BN is the palate, accounting for 75% of the cases, followed by the labial mucosa. There’s a slight female predilection, but mostly in the third and forth decades. Only 2% of BN are seen in children. While the treatment of choice is surgical excision, this pratice is somewhat controversial. It’s recommended because the lesion is constantly subjected to trauma, which makes it hard to monitor changes in size and appearance, which may mimic melanoma. While malignant transformation of BN has been implicated in children, there are no intra oral examples of this. Some risk factors of malignant transformation include a new or changing nevus, the presence of multiple nevi, fair skin, family history of melanoma, congenital nevus, and immunosuppression. Differential diagnosis of BN includes amalgam tattoo, melanotic macule, and various vascular anomalies. In terms of amalgam tattoo, a good history of trauma and past dental procedures is important.

Summary of conclusions: In summary, the BN is an extremely rare lesion seen in the oral cavity of a child. Take a good medical history to rule out other possible causes and diagnosis, and when in doubt, excise the entire lesion. This is because should the lesion turn malignant, the overall 5 year survival rate for oral melanomas is less then 15%.

Assessment of article:Good article. It was quick to the point. Easy to read. Good summary.