A Clinicopathological Study of 22 Cases of Oral Melanotic Macule

22例口腔黑斑之臨床病理研究

陳皇旭(Huang-Hsu Chen) ； 余權航(Chuan-Hang Yu) ； 王拯宗(Jeng-Tzung Wang) ； 王逸平(Yi-Ping Wang) ； 劉步遠(Bu-Yuan Liu) ； 孫安迪(Andy Sun) ； 李正喆(Jang-Jaer Lee) ； 江俊斌(Chun-Pin Chiang)

《中華牙醫學雜誌》 23卷5期 (2004/10) Pp. 345-352

https://doi.org/10.7105/CDJ.200410.0345

摘要

口腔黑斑或黑色素沈著是一種不常見的口腔黏膜病變。本研究分析從1989年l月至2004年6月間，於台大醫院口腔病理及診斷科檔案之22例口腔黑斑病例。22位患者中8位為男性，14位為女性。患者於最初診斷時之平均年齡為41.2歲（範圍，5-80歲）。口腔黑斑最常發生於頰黏膜（7例）及下唇（6例）。多發性病變有5例，病變之外表最常為黑色（19例）。22例口腔黑斑中，其最大徑最長者為1.5cm，平均為5mm。12例之臨床診斷為口腔黑色素沈著，6例為口腔黑斑，2例為黏膜內痣，另2 為其他診斷。21例以手術切除治療，l例只作切取式切片檢查。3例於手術後再發。組織病理檢查發現每mm長度基底膜之黑色素沈著基底上皮細胞平均密度，頰黏膜病變(14±26)比下唇(89±62, p=0.014)或牙齦病變(76±62, p=0.041)明顯較低；但每mm長度基底膜之上皮下方結締組織中噬黑色素細胞平均密度，頰黏膜病變(52±29)比牙齦病變(14±2)明顯較高(p=0.031)，但頰黏膜病變與下唇病變(28±16)二者之間無統計學上有意義之差異(p=0.1)。結論是口腔黑斑最常發生於40至50歲患者，最常發生於頰黏膜和下唇。頰黏膜口腔黑斑外觀為黑色之主要原因可能為上皮下方結締組織中之噬黑色素細胞增加。而下唇或牙齦口腔黑斑外觀為黑色之主要原因可能為黑色素沈著之基底上皮細胞增加。

關鍵字

黑班 ； 黑色素沈著 ； 口腔黏膜 ； 臨床特徵 ； 組織學特徵

並列摘要

Oral melanotic macules, or melanosis, are uncommon oral mucosal lesions. Twenty-two cases of oral melanotic macule diagnosed and treated in our institute during the period from January 1989 to June 2004 were analyzed in this study. There were 8 male and 14 female patients. The mean age of patients at the time of diagnosis was 41.2 (range, 5~80) years. The most-common sites for melanotic macule were the buccal mucosa (7 cases) and lower lip (6 cases). Multiple lesions were noted in 5 cases. The clinical appearance of the lesion was frequently a black macule (19 cases). The greatest dimension of the lesion was 1.5cm with a mean of 0.5cm. Of the 22 cases, the clinical diagnosis was oral melanosis in 12, oral melanotic macule in 6, intramucosal nevus in 2, and others in 2. Excisional biopsy was the treatment of choice in 21 cases and incisional biopsy in 1 case. Recurrence of the lesion was found in 3 cases. We found that buccal mucosal lesions had a significantly lower mean density of pigmented basal epithelial cells/mm of the basement membrane (14±26 cells/mm) than of the lower lip (89±62 cells/mm, p=0.014) or gingival lesions (76±62 cells/mm, p=0.041). In contrast, buccal mucosal lesions had a significantly higher mean density of melanophages/mm of basement membrane(52±29 cells/mm) than gingival lesions (14±2 cells/mm, p=0.031). However, there was no significant difference ii the mean density of melanophages/mm of the basement membrane between buccal mucosal lesions and lower lip lesions (28±16 cells/mm, p=0.1). We concluded that oral melanotic macules in this study occurred most often in the fifth decade. The most-commonly affected sites were the buccal mucosa and lower lip. The black pigmentation of these buccal mucosal melanotic macules might have been due to an increase in the number of melanophages in the subepithelial connective tissue, and the black pigmentation of lower lip or gingival melanotic macule might have been due to an increase in the number of melanin-pigmented basal epithelial cells.

並列關鍵字

melaniotic macule ； melanosis ； oral mucosa ； clinical feature ； histological feature