Oral Cavity Pigmented Lesions: A Narrative Review on Clinical and Diagnostic Perspectives

The human oral mucosa exhibits a wide array of color variations, influenced by both genetic and environmental factors. These variations range from physiological differences in individuals with lighter or darker skin tones to pathological changes caused by trauma, inflammation, hormonal fluctuations, and exposure to pharmacological agents. Pigmented lesions in the oral cavity present a diagnostic challenge due to their diverse etiologies, which include benign conditions such as melanotic macules and smoker’s melanosis, as well as more serious pathologies like oral melanoma and systemic disorders such as Addison’s disease and Peutz-Jeghers Syndrome. The differential diagnosis is further complicated by multifactorial causes, including both endogenous factors, such as nevi, and exogenous ones, such as amalgam tattoos. This review provides a comprehensive examination of the causes, diagnostic challenges, and clinical management of oral mucosal pigmentation. It underscores the importance of distinguishing between physiological and pathological states, highlighting the need for a detailed understanding of the underlying mechanisms and careful diagnostic evaluation in clinical practice.