Oral pigmented lesion: a case report

A 67-year-old female patient presented in intraoral examination a darkened spot in the maxilla region above the central incisors, near the bottom of the vestibule, which extended to the hard palate. She reported that, 52 years ago, she had suffered a trauma that resulted in fracture of tooth 21, and a paraendodontic surgery was performed with apicectomy and insertion of metallic material, but there was no success, and the tooth was extracted. Diagnostic hypotheses considered were as follows: extrinsic pigmentation, melanoma, and melanosis by nevus cells. Periapical radiography was performed, but no metallic fragment was found. Then, an incisional biopsy was performed with a final diagnosis of amalgam tattoo. There was no recurrence in 6 months follow-up. It is concluded that, regardless of the extension, location, and nonidentification of a radiopaque fragment on radiographs, the previous clinical history is important for appropriate diagnosis and management.