An 82- year-old female patient came into the student clinics with a self-diagnosis of melanoma. The "black" spot had been present for a "long time". Although the lesion was asymptomatic, she thought that there had been a recent increase in size.
The patient was reasonably good health, especially considering her age.
The extra-oral examination was unremarkable. Intra-oral examination revealed a 7 x 6 mm grayish lesion in anterior maxillary gingiva.
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| 82-year old female with amalgam tattoo |
I asked the patient if there was any history was treatment in the area, she responded in negative. I told the student to get radiographs.
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| Radiographic presentation of an amalgam tattoo |
I hope you can see the radio-opacity in the anterior region corresponding to the site of the lesion. My final diagnosis was an amalgam tattoo.
I explained to the patient that a previous procedure had led to incorporation of amalgam particles in the gingiva. The material is biocompatible and no treatment is warranted unless she has esthetic concerns. The patient decided to keep her tattoo.
Amalgam Tattoo:
Amalgam is a silver-colored filling material that is used to restore teeth. Amalgam particles can get embedded in the mucosa during placement or removal of the filling material. It has also been used to restore root apices following a retrograde root canal procedure (also known as apicoectomy). Although the patient was unable to provide a good dental history, I believe that the patient had undergone an apicoectomy procedure on one of her incisor leading to large deposit of material in the area.
It is important to note that not all amalgam tattoos have particles that can be identified through radiographs. In such instances, a biopsy may be mandated. Amalgam tattoos have a characteristic histologic appearance.
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